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Bisphosphonate-related bilateral femoral fractures

Case contributed by Henry Knipe
Diagnosis certain

Presentation

Thigh pain.

Patient Data

Age: 65 years
Gender: Female

Pelvis and right femur

x-ray

Complete fracture of the mid proximal femoral shaft with a transverse orientation of the fracture line medial "beaking". Distal rotation and displacement. 

Cortical thickening of the anterolateral aspect of the proximal mid femoral shaft. 

Case Discussion

This patient had a history of long-term bisphosphonate use, and these are the characteristic patterns of complete and incomplete femoral fractures. Imaging of the contralateral femur is recommended as it can show an early/incomplete insufficiency fracture such as in this case. These are at higher risk of complete fracture, and are sometimes prophylactically treated with an IM nail. 

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