Search

Introduction: Long-term bisphosphonate therapy for osteoporosis is associated with an increased risk of low-to-no energy atypical subtrochanteric and femoral shaft fractures with characteristic radiologic findings. There are few reports of patients with long-term bisphosphonate-induced periprosthetic fractures, all of them had a hip arthroplasty prosthesis. In this report, we present a unique case of a 90-year-old Caucasian female on long-term bisphosphonate therapy with a sliding hip screw implant who sustained a periprosthetic fracture of the femoral shaft at the distal aspect of the plate. Case Report: In April 2014, a 90-year-old female presented with left thigh pain after a fall from standing height. She had a previous fixation of a left intertrochanteric hip fracture with a sliding hip screw in 1999 and a 9-year history of bisphosphonate therapy. Radiographs obtained in the emergency department revealed a left-sided femoral shaft fracture at the distal aspect of the previously applied five-hole side plate. Of note, the periprosthetic fracture demonstrated cortical thickening at the fracture site of the lateral femoral cortex, lack of comminution as well as a transverse appearance. The patient was taken to the operating room the next day for retrograde placement of an intramedullary nail of the left femur with revision of left intertrochanteric femur fracture fixation. By 3 months postoperatively, she had obtained full radiographic union. Conclusion: This case report highlights the possibility of an atypical fracture distal to the sliding hip screw implant after open reduction internal fixation of an intertrochanteric hip fracture in patients on long-term bisphosphonates.

Introduction: Chronic osteomyelitis is a disease that requires fastidious treatment to eliminate. However, when eradication is unable to be achieved through exhaustive modalities of antibiotic therapy and multiple debridements, significant resection of the infected bone and soft tissue must be considered, including amputation. Here we report of a salvage procedure for chronic osteomyelitis of the left tibia by employing a rotationplasty to avoid an above knee amputation and instead provide the patient with a below knee amputation. Case Report: A 51-year-old male presented to the emergency department after noticing dehiscence of an operative wound with exposure of an implant in the left lower extremity. Two years prior to presentation, the patient was involved in a motorcycle accident and underwent four surgeries in the Dominican Republic for an open fracture of the left tibia and fibula, including a procedure that involved the placement of an implant in the left proximal tibia. Tissue biopsies from the wound confirmed that the patient had osteomyelitis of the left proximal tibia. After extensive surgical and antibiotic intervention to eradicate the patient’s osteomyeltis, it was eventually determined that an amputation would be necessary. In order to avoid an above knee amputation, a salvage procedure was conducted by employing a rotationplasty to provide the patient with a below knee amputation. Conclusion: When amputation is deemed necessary, sparing the knee joint is associated with decreased energy expenditures, increased patient satisfaction and overall better postoperative outcomes. As part of a multi-disciplinary team, orthopaedics, plastic surgery, infectious disease, and medical services successfully treated this case of chronic osteomyelitis of the left proximal tibia by employing a rotationplasty to avoid an above knee amputation and achieve a below knee amputation.