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Journal of Orthopaedic Science
Published in: Journal of Orthopaedic Science 4/2014

01-07-2014 | Original Article

Stress fracture of the bowed femoral shaft is another cause of atypical femoral fracture in elderly Japanese: a case series

Authors: Yoto Oh, Yoshiaki Wakabayashi, Yoshiro Kurosa, Masafumi Ishizuki, Atsushi Okawa

Published in: Journal of Orthopaedic Science | Issue 4/2014

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Abstract

Background

We have studied stress fractures of the bowed femoral shaft (SBFs) among elderly Japanese for over a decade. On the other hand, severely suppressed bone turnover (SSBT) after long-term bisphosphonates (BPs) use has been considered to be one of the causes of low-energy diaphyseal femoral fractures, often called atypical femoral fractures (AFFs). Some studies have shown that BPs use for more than 5 years is associated with an increased risk of AFFs. Here, we present a report of our SBF case series experienced in the past 15 years in order to examine whether bowing deformity should be considered among the causes of AFFs.

Methods

Subjects were 13 Japanese female patients with low-energy femoral shaft fractures. Mean age at injury was 77.0 years (range 67–88 years). All patients met the criteria of the AFFs’ case definition. The first author treated 11 of the 13 patients over 8 years (2005–2012) based on the concept of SBFs. Regarding the regional characteristics of these patients, 10 were treated at 2 rural hospitals, and 3 were treated at 3 urban hospitals. Retrospectively, we assessed fracture type and location, existence of fracture on the contralateral side, bowing deformity, and duration of BPs use.

Results

All 13 cases were AO/OTA type 32-A. Incomplete or previous fracture on the contralateral side was noted in 10 cases. Obvious bowing deformity of the femoral shaft was noted in 12 cases. BPs were taken in 7 cases, only 3 of which involved BPs use for more than 5 years.

Conclusions

We experienced 12 cases of low-energy femoral shaft fractures associated with bowing deformity. Six cases were not treated with BPs at all. Stress fractures associated with a femoral shaft bowing deformity do actually exist and should be recognized as another cause of AFFs.
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Metadata
Title
Stress fracture of the bowed femoral shaft is another cause of atypical femoral fracture in elderly Japanese: a case series
Authors
Yoto Oh
Yoshiaki Wakabayashi
Yoshiro Kurosa
Masafumi Ishizuki
Atsushi Okawa
Publication date
01-07-2014
Publisher
Springer Japan
Published in
Journal of Orthopaedic Science / Issue 4/2014
Print ISSN: 0949-2658
Electronic ISSN: 1436-2023
DOI
https://doi.org/10.1007/s00776-014-0572-9

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