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The tyrosine kinase inhibitor, JNJ-42756493, is an oral pan-fibroblast growth factor receptor inhibitor being studied as an antineoplastic agent. It is currently the subject of a phase II clinical trial for the treatment of urothelial cancer. We report 2 patients who developed visual disturbance shortly after starting or increasing dosage of this medication and were found to have bilateral foveal detachments on ocular coherence tomography imaging. The first patient discontinued this medication and the retinal lesions resolved with a return to baseline vision within 4 to 6 weeks. After restarting the medication at a lower dose, neither visual disturbance nor retinal lesions recurred. In the second patient, lesions were found to greatly improve shortly after discontinuation of the medication but recurred even on a reduced dose regimen.

Introduction In the prevention of venous thrombo-embolic events (VTEs) in isolated low-energy fracture patients, management guidelines are conflicting and prior literature is lacking. We aimed to determine the incidence and factors associated with the development of symptomatic VTE in this patient cohort. Materials and methods To identify patients with isolated, low-energy fractures, we studied billing records from all admissions to our tertiary care orthopaedic hospital from 2007 to 2009. We used International Classification of Diseases, 9th Revision codes to identify patients who developed deep vein thrombosis (DVT) and/or pulmonary embolism (PE) during their hospital admission or within 90 days of discharge. We also collected data on socio-demographics, type of injury, fracture treatment, co-morbidities and anticoagulation therapy at time of admission. This study was a retrospective review of a database. Results In total, 1701 admissions fit our criteria. Average patient age was 64.27 years and 64.4% were female. There were 479 (28.2%) upper extremity fractures and 1222 (71.8%) lower extremity fractures. Incidence of clinically significant VTE was 1.4%. Of the 24 patients with 25 documented VTE, there were 13 DVTs and 12 PEs, including 2 fatal PEs (0.012%). Nineteen VTEs occurred in association with lower extremity fractures and six with upper extremity fractures; 74% of patients were chemoprophylaxed. Patients with VTE had an average age of 69.5 years and an average body mass index (BMI) of 28kgm −2 . Logistical regression analysis found female sex ( p =0.05) and elevated BMI ( p =0.003) to be the only significant predictors of VTE. Conclusions Clinically significant VTE among patients who sustained isolated, low-energy fractures was found to be low in the setting of standard VTE prophylaxis. Our incidence was consistent with that of patients undergoing total hip arthroplasty. Female sex and increased BMI were statistically significant predictors of VTE.

Objective: To describe the outcomes for patients treated at a single institution, who sustained incomplete bisphosphonate-induced femoral fractures. Design: Retrospective review. Setting: University-based academic medical center. Patients: Thirty-one patients with 43 incomplete fractures met the inclusion criteria. Intervention: Nonoperative management or surgical intervention for fractures with refractory symptoms or progression of fracture lucency on radiographs. Main Outcome Measurements: Radiographic assessments and the Short Musculoskeletal Functional Assessment to gauge functional status. Results: The cohort was all women with an average age of 69.2 (range: 46–92) years and had been treated with bisphosphonate therapy for an average of 9.1 (range: 5–20) years. The average healing time for all incomplete fractures was 9.4 (range: 1.5–36) months. Forty-nine percent of the fractures (21 of 43 fractures) were ultimately treated with surgery for impending complete fracture or failure of nonsurgical management. Of the incomplete fractures treated with surgery, 81% became pain free and 100% were radiographically healed at a mean of 7.1 (range: 1.5–12) months. In contrast, of the nonoperatively treated incomplete fractures, only 64% were pain free at latest follow-up, with only 18% of fractures demonstrating radiographic evidence of healing at an average of 11 (range: 6–24) months. Standardized dysfunction index from the Short Musculoskeletal Functional Assessment was better (19.7) in the surgical group than in the nonsurgical group (19.7 vs. 25.7, P = 0.0017). Conclusions: A higher percentage of patients treated surgically became asymptomatic and demonstrated radiographic evidence of healing earlier than those treated nonsurgically. Surgical intervention is effective for relief of symptoms when treating incomplete bisphosphonate-related femur fractures, and patients should be counseled to the potential benefits of prophylactic surgery. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.