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- Same-site recurrence of an incomplete atypical femoral fracture 8 years after prophylactic intramedullary nailing following bisphosphonate re-exposure in an 81-year-old woman in Korea: a case report
- Youngho Cho, Changhun Lim
- Received May 31, 2026 Accepted July 1, 2026 Published online September 21, 2026
- DOI: https://doi.org/10.12671/jmt.2026.00227 [Epub ahead of print]
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Abstract
PDF - An 81-year-old woman with osteoporosis presented in April 2024 with recurrent right thigh pain, 8 years after prophylactic intramedullary nailing for an incomplete atypical femoral fracture (AFF) in February 2016. She had a history of bisphosphonate use for approximately 10 years followed by a 5-year drug holiday and three ibandronate infusions before the index fracture in 2016; after a subsequent 4-year antiresorptive-free interval, bisphosphonate therapy was resumed in 2020–2021 following a new vertebral compression fracture. Plain radiographs in 2024 showed recurrent lateral cortical thickening and a transverse radiolucent line at the same site as the previous lesion, with intact hardware. Bone scintigraphy confirmed intense uptake consistent with a recurrent stress reaction. Laboratory testing showed markedly suppressed bone turnover markers, with a serum β-isomerized C-terminal telopeptide of type I collagen (β-CTX) level of 0.048 ng/mL, below the lower limit of the reference range (0.112 ng/mL). The lesion healed during conservative management consisting of bisphosphonate discontinuation, calcium and vitamin D supplementation, retained mechanical stabilization, and a 4-month course of off-label teriparatide. The independent contribution of teriparatide cannot be determined from this single case. This case highlights the rare phenomenon of same-site incomplete AFF recurrence long after prophylactic fixation in association with bisphosphonate resumption and describes successful conservative healing with short-term teriparatide in the presence of preexisting hardware. Level of evidence: V.
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- Pseudoaneurysm of the Anterior Tibial Artery after Reduction with Pointed Bone Reduction Forceps on a Spiral Fracture of the Distal Tibia: A Case Report
- Hyunseung Yoo, Youngho Cho, Seongmun Hwang
- J Korean Fract Soc 2019;32(1):43-46. Published online January 31, 2019
- DOI: https://doi.org/10.12671/jkfs.2019.32.1.43
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Abstract
PDF
- This paper reports a pseudoaneurysm of the anterior tibial artery after reduction with pointed bone reduction forceps on a spiral fracture of the distal tibia. Most reported injuries occurred at the proximal part of anterior tibial artery during drilling of the proximal tibia. To the best of the authors' knowledge, injury of the distal part of anterior tibial artery has never been reported. This paper describes a 54-year-old woman with a pseudoaneurysm of the anterior tibial artery clinically detected 11 weeks after the index surgery. This report highlights the need for surgeons to be aware of and careful about this complication during and after surgical intervention.
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