A Rare Case of an Intertrochanteric Hip Fracture Combined with an Ipsilateral Incomplete Atypical Femoral Fracture Treated with a Long Gamma Intramedullary Nail.

Introduction: Osteoporotic hip fractures can occur at the femoral neck and intertrochanteric area, with the peritrochanteric fracture being responsible for half of these fractures in the geriatric population. Atypical femoral fractures have been associated in the literature with long-term use of bisphosphonates or denosumab. However, few cases with the characteristics of these fractures have been reported in the past in patients not receiving antiresorptive drugs. To date, no combination of an intertrochanteric fracture with an impending incomplete atypical fracture of the ipsilateral femoral diaphysis has been previously reported in the literature. Case Report: We present a rare case of a 97-year-old female patient with an intertrochanteric femoral fracture, with a preexisting focal cortical thickening along the lateral aspect of the ipsilateral proximal femoral diaphysis which is a warning sing for an incomplete atypical femoral fracture. A long gamma nail was used to fix the intertrochanteric fracture and simultaneously to stabilize and protect the area of the atypical femoral fracture. Conclusion: Any patient with a peritrochanteric hip fracture who was under long-term treatment with antiresorptive agents against osteoporosis, or has other risk factors predisposing to atypical femoral fracture, should undergo a thorough radiological examination of the ipsilateral femur, to exclude the possibility of simultaneous presence of both of the above pathologies. In any such case, the use of a long hip cephalomedullary nail seems to be the best treatment option, because it can treat both fractures at the same time.

Atypical Femoral Fracture in a Patient without Bisphosphonate or Denosumab Exposure-A Case Report.

Introduction: Atypical femoral fractures (AFF) are associated with the use of bisphosphonates (BPs) or denosumab. However, few cases that meet the characteristics of these fractures, as established by the American Society of Bone and Mineral Research, have occurred in patients who have never used antiresorptive drugs. Case Report: We report a case of AFF in a 67-year-old woman who had never used antiresorptive medications. The history and comorbidities of the patient, the characteristics of the fracture, and the subsequent treatment are presented. Conclusion: AFFs may occur even in patients who have never been exposed to BPs or denosumab. The absence of antiresorptive osteoporosis therapy and the lack of radiographic focal periosteal reaction in the lateral femoral cortex, as in our case, can make it difficult to detect and prevent the disorder. Prolonged use of proton pump inhibitors and Vitamin D deficiency-related osteomalacia may contribute to the occurrence of these fractures. Further studies are required to accurately understand all inciting factors contributing to the development of AFFs.