[Subtrochanteric pathological fracture on bisphosphonates]. / Le cas clinique du mois. Fracture pathologique sous-trochantérienne sur prise de bisphosphonates.

Bisphosphonates have frequently shown their efficacy in the treatment of osteoporosis, including ibandronate and alendronate. But more and more mention is made in the literature of patients taking a long-term bisphosphonate and undergoing an atypical fracture associated with this therapy. These complications are most often femoral fractures in the proximal part of the femoral diaphysis. We report the case of a 73-year-old patient who had a subtrochanteric pathological fracture after a prolonged intake of alendronate followed by ibandronate.

Les bisphosphonates ont fréquemment démontré leur efficacité dans le traitement de l'ostéoporose, notamment l'ibandronate et l'alendronate. Mais, de plus en plus, il est fait mention dans la littérature de cas de patients traités par un bisphosphonate au long cours et présentant une fracture atypique qui y serait liée. Il s'agit, le plus souvent, de fractures fémorales dans la partie proximale de la diaphyse. Nous rapportons ici le cas d'une patiente de 73 ans ayant subi une fracture pathologique sous-trochantérienne après une prise prolongée d'alendronate suivie d'une prise d'ibandronate.

Critical shoulder angle: Measurement reproducibility and correlation with rotator cuff tendon tears.

BACKGROUND: Associations have been reported linking rotator cuff tears (RCTs) to both greater lateral extension of the acromion and greater inclination of the glenoid cavity. These two factors combined can be assessed using a recently introduced parameter, the critical shoulder angle (CSA). The primary objective of this study was to confirm the association linking a high CSA value to RCTs, and the secondary objective was to assess the reproducibility of CSA measurement using a goniometer. HYPOTHESIS: The null hypothesis was that the CSA value in a group of patients with RCTs was not significantly different from that in patients with anterior shoulder instability and a Bankart lesion, taken as the general population for this study. METHODS: After a power estimation, we retrospectively included 28 patients with a mean age of 55.5 years who had surgery for RCTs and 27 patients with a mean age of 27.2 years who underwent anterior labral repair. Two surgeons used a goniometer to measure the CSA in each patient. Reproducibility was assessed based on Bland-Altman plots and Pearson's correlation coefficient. RESULTS: The mean CSA was significantly higher (P=0.02) in the RCT group (36.4°±4.4°; range: 30°-46°) than in the labral-repair group (33.3°±3.8°; range: 25°-41°). Intra-observer reproducibility was 96.7% and inter-observer reproducibility was 95.5%. CONCLUSION: Our results support previously published evidence that the CSA is significantly greater in patients with RCTs. Thus, an anatomical difference seems to exist between patients with RCTs and the general population. The CSA measured on a standard radiograph using a goniometer provides a reproducible assessment of this anatomical difference. LEVEL OF EVIDENCE: IV, case-control epidemiological study with a power estimation.