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HOME > J Musculoskelet Trauma > Volume 33(2); 2020 > Article
Case Report Treatment of Atypical Ulnar Fracture Associated with Bisphosphonate Therapy - A Case Report -
Dong-Soo Kim, Ji-Kang Park, Eui-Sung Choi, Ho-Seung Jeong, Seok-Hyun Hong, Byung-Hyun Ahn
Journal of Musculoskeletal Trauma 2020;33(2):101-104.
DOI: https://doi.org/10.12671/jkfs.2020.33.2.101
Published online: April 30, 2020
Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea

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Abstract

Bisphosphonates can cause atypical fractures when taken for a long time. Atypical fractures appear mainly as femoral subtrochanteric or shaft fractures. On the other hand, reports of atypical fractures in the proximal ulna are relatively rare, with a high proportion of nonunion cases. This paper reports a case of nonunion after fixation for atypical fractures of the proximal ulna.


J Korean Fract Soc. 2020 Apr;33(2):101-104. Korean.
Published online Apr 28, 2020.
https://doi.org/10.12671/jkfs.2020.33.2.101
Copyright © 2020 The Korean Fracture Society. All rights reserved.
Case Report

Treatment of Atypical Ulnar Fracture Associated with Bisphosphonate Therapy: A Case Report

Dong-Soo Kim, M.D., Ji-Kang Park, M.D., Ph.D., Eui-Sung Choi, M.D., Ph.D., Ho-Seung Jeong, M.D., Seok-Hyun Hong, M.D. and Byung-Hyun Ahn, M.D.
    • Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
  • Ji-Kang Park, M.D., Ph.D. Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 776, 1Sunhwan-ro, Seowon-gu, Cheongju 28644, Korea. Tel: +82-43-269-6077, Fax: +82-43-274-8719, Email: carm0916@gmail.com
Received December 04, 2019; Revised December 18, 2019; Accepted March 29, 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Bisphosphonates can cause atypical fractures when taken for a long time. Atypical fractures appear mainly as femoral subtrochanteric or shaft fractures. On the other hand, reports of atypical fractures in the proximal ulna are relatively rare, with a high proportion of nonunion cases. This paper reports a case of nonunion after fixation for atypical fractures of the proximal ulna.

Keywords
Atypical ulnar fracture, Nonunion, Bisphosphonate, Bone graft

Figures

Fig. 1
Initial anteroposterior (A) and lateral (B) radiographs show a transverse fracture of the right proximal ulna with cortical thickening and marginal sclerosis.

Fig. 2
After 3 months, there was no evidence of union, but metal breakage of the plate had occurred.

Fig. 3
Anteroposterior (A) and lateral (B) radiographs after the second operation.

Fig. 4
Nine months after the second operation, radiological nonunion and implant loosening was observed.

Fig. 5
The operation was performed with an olecranon plate and forearm plate.

Fig. 6
Radiographs 1 year and 10 months after surgery show maintained bone union.

Notes

Financial support:None.

Conflict of interests:None.

References

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    1. Silverman S, Kupperman E, Bukata S. Bisphosphonate-related atypical femoral fracture: managing a rare but serious complication. Cleve Clin J Med 2018;85:885–893.
    1. Mahjoub Z, Jean S, Leclerc JT, et al. Incidence and characteristics of atypical femoral fractures: clinical and geometrical data. J Bone Miner Res 2016;31:767–776.
    1. Khow KS, Shibu P, Yu SC, Chehade MJ, Visvanathan R. Epidemiology and postoperative outcomes of atypical femoral fractures in older adults: a systematic review. J Nutr Health Aging 2017;21:83–91.
    1. Ito H, Miyakoshi N, Kasukawa Y, et al. Treatment of atypical fracture of the ulnar diaphysis by open reduction and internal fixation with teriparatide. Case Rep Orthop 2019;2019:9103412
    1. Tan SH, Saseendar S, Tan BH, Pawaskar A, Kumar VP. Ulnar fractures with bisphosphonate therapy: a systematic review of published case reports. Osteoporos Int 2015;26:421–429.
    1. Koh A, Guerado E, Giannoudis PV. Atypical femoral fractures related to bisphosphonate treatment: issues and controversies related to their surgical management. Bone Joint J 2017;99:295–302.
    1. Kong KM, Kwon YU, Min YK, Kim DY. Ulnar insufficiency fractures in patients on prolonged bisphosphonate therapy: a case report. J Korean Fract Soc 2019;32:143–147.
    1. Egol KA, Park JH, Prensky C, Rosenberg ZS, Peck V, Tejwani NC. Surgical treatment improves clinical and functional outcomes for patients who sustain incomplete bisphosphonaterelated femur fractures. J Orthop Trauma 2013;27:331–335.
    1. Niéto H, Billaud A, Rochet S, et al. Proximal ulnar fractures in adults: a review of 163 cases. Injury 2015;46 Suppl 1:S18–S23.
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    Treatment of Atypical Ulnar Fracture Associated with Bisphosphonate Therapy - A Case Report -
    J Korean Fract Soc. 2020;33(2):101-104.   Published online April 30, 2020
    DOI: https://doi.org/10.12671/jkfs.2020.33.2.101
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