Fracture Occurrence following Prophylactic Nailing in a Case of Bisphosphonate-induced Atypical Femoral Fracture - A Rare Case Report.

INTRODUCTION

Bisphosphonates are effective in osteoporosis management but have been linked to atypical femoral fractures (AFFs) with prolonged use. The management of incomplete AFF remains controversial, particularly regarding the role of prophylactic fixation.

CASE REPORT

A 67-year-old female on long-term bisphosphonate therapy presented with a left subtrochanteric fracture following a minor fall. Imaging revealed an impending AFF in the contralateral right femur, leading to prophylactic intramedullary nailing. Six weeks postoperatively, she developed a minimally displaced fracture on the right femur, which was managed conservatively due to the minimal displacement of the fracture as a result of prophylactic nailing. She achieved full fracture healing and unaided mobility without additional surgical intervention.

CONCLUSION

Prophylactic intramedullary nailing can effectively mitigate fracture displacement and the need for re-surgery in patients with impending AFF. However, further studies are needed to establish standardized management protocols.