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Case Reports
. 2020 Dec 10:31:100381.
doi: 10.1016/j.tcr.2020.100381. eCollection 2021 Feb.

Valgus osteotomy for atypical interprosthetic femoral fracture with lateral bowing of the femur

Sammy Banno  1 , Tomonori Baba  1 , Hiroki Tanabe  1 , Seiya Ishii  1 , Yuta Jinnai  1 , Yasuhiro Homma  1 , Taiji Watari  1 , Kazuo Kaneko  1
Affiliations
Case Reports

Valgus osteotomy for atypical interprosthetic femoral fracture with lateral bowing of the femur

Sammy Banno et al. Trauma Case Rep. .

Erratum in

Abstract

Introduction: In recent years, it has been reported that periprosthetic femoral fractures in the form of atypical femoral fractures (AFFs) are found occasionally as difficult-to-treat conditions. To date, there have been no reports of interprosthetic femoral fractures (IPFFs) having the form of AFFs. We report a case of an atypical IPFF with breakage of the plate due to abnormal femoral alignment.

Case report: A 70-year-old woman was admitted. She underwent left knee replacement and left hemi-arthroplasty at ages 61 and 60. And she had been taking bisphosphonate for 5 years. A plain X-ray revealed IPFF. The fracture was a complete transverse fracture with circumscribed thickening of the lateral cortical bone ("beak sign") at the fracture site. She underwent surgery. A reversed condylar locking compression plate (LCP) was used for internal fixation. Subsequently, she could walk without particular pain. Five months after the operation, she heard the snap of a bone breaking, and had difficulty walking. Plain X-ray revealed a re-fracture of the fracture site and breakage of the plate at the same high position. She underwent re-operation. A valgus osteotomy was performed at an angle of 15°. A reversed condylar LCP was used on the lateral side of the femur. A bone grafting was performed focusing on the fracture site. In addition, a short-LCP was fixed anteriorly to the femur. The bone union 1 year and 6 months postoperatively. She could walk, with no impairment being noted regarding ADL.

Conclusions: We performed osteosynthesis for an IPFF having the characteristics of AFF, but the patient suffered breakage of the plate and re-fracture. Bone union was achieved as a result of re-operation that consisted of valgus osteotomy of the fracture site in combination with autologous bone grafting and double orthogonal plating.

Keywords: Atypical femoral fracture; Atypical interprosthetic femoral fractures; Interprosthetic femoral fracture; Orthogonal plate; Re-fracture; Valgus osteotomy.

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Conflict of interest statement

The author(s) declare(s) no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Fig. 1
Fig. 1
The radiographs of the femoral (anterior view). a: The first injury. The fracture was a complete transverse fracture. b: After the first surgery. c: The 5 months after the first surgery. Re-fracture of the fracture site and breakage of the plate.
Fig. 2
Fig. 2
The radiographs of the femoral (anterior view: after re-operation). a: After re-operation. Femur laterally bowing was improved. The short plate was fixed anteriorly to the femur. b: 6 months postoperatively. The callus formation was observed. c: 1 year and 6 months postoperatively. The bone union was observed.
Fig. 3
Fig. 3
Standing lower limb full length simple X-ray (anteroposterior view) time series. The solid line is the functional axis. a: Before the first injury. The femur laterally bowing was observed. b: The 3 months after the first surgery. The femur laterally bowing was observed. c: The 4 months post re-operation. The femur laterally bowing was improved.
See this image and copyright information in PMC

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