Rescate de pseudoartrosis asociada a falla de osteosíntesis en fractura femoral por bifosfonatos.: Reporte de un caso y revisión de la literatura.

• Matias Pereira Duarte ^[1] ; Jonathan M. Verbner ^[1]
  1. [1] Hospital Italiano de Buenos Aires

     Hospital Italiano de Buenos Aires

     Argentina

     
• Localización: Revista de la Asociación Argentina de Ortopedia y Traumatología, ISSN 1852-7434, Vol. 82, Nº. Extra 4 (Suplemento), 2017, págs. 8-14
• Idioma: español
• DOI: 10.15417/2525-1015.2017.82.712
• Títulos paralelos:
  • Nonunion rescue associated with osteosynthesis failure in femoral fracture due to bisphosphonates: Case report and literature review
• Enlaces
  • Texto completo (pdf)
• Resumen
  • español

    Introducción: Las fracturas asociadas al consumo crónico de bifosfonatos son entidades descriptas recientemente en la literatura médica que presentan altas tasas de pseudoartrosis. Presentamos aquí un caso de rescate de pseudoartrosis de fractura femoral subtrocantérica atípica por bifosfonatos asociada a falla de material de osteosíntesis, tratada finalmente con clavo endomedular cervicodiafisario e injerto estructural de peroné.Presentación del caso: Mujer de 73 años con antecedente de osteoporosis y 6 años de tratamiento con bifosfonatos, sufre una fractura atípica femoral subtrocantérica. Tratada inicialmente en otro centro con placa con tornillo deslizante de cadera. Al cumplirse un año postoperatorio, presenta una falla del material de osteosíntesis asociada a pseudoartrosis del foco de fractura. Presentamos aquí su rescate mediante un clavo cervicodiafisario e injerto óseo autólogo de peroné.Conclusión: El tratamiento con clavo cervicodiafisario más injerto autólogo podría considerarse una técnica efectiva para el tratamiento de la pseudoartrosis en fracturas femorales asociadas a bifosfonatos y déficit de stock óseo.

  • English

    Fractures associated with chronic use of bisphosphonates are recently described entities, with high rates of nonunion. We report a case of nonunion rescue of an atypical subtrochanteric bisphosphonate femoral fracture associated with osteosynthesis failure, which was finally treated using an intramedullary nail and structural fibular graft.

    Treatment with autologous graft and neck-nail is indicated for nonunion in femoral fractures associated with bisphosphonates.

• Referencias bibliográficas
  • Park-Wyllie LY, Mamdani MM, Juurlink DN, Hawker GA, Gunraj N, Austin PC et al. Biphosphonate use and therisk of subtrochantericor femoral...
  • Lenart BA, Lorich DG, Lane JM. Atypical Fractures of the Femoral Diaphysis in Postmenopausal Wome nTaking Alendronate. N Engl J Med 2008;...
  • Shane E, Burr D, Ebeling PR, Abrahamsen BO, Adler RA, Brown TD et al. Atypical Subtrochanteric and Diaphyseal Femoral Fractures: Report of...
  • Grosso A, Douglas I, Hingorani A, MacAllister R, Smeeth L. Oral bisphosphonates and risk of atrial fibrillation and flutter in women: a self-controlled...
  • Mashiba T, Hirano T, Turner CH, Forwood MR, Johnston CC, Burr DB. Suppressed Bone Turnover by Bisphosphonates Increases Microdamage Accumulation...
  • Unnanuntana A,Saleh A, Mensah KA, Kleimeyer JP, Lane JM. Atypical Femoral Fractures: What Do We Know About Them? AAOS Exhibit Selection. J...
  • Shane E, Burr D, Abrahamsen Bo, Adler RA, Brown TD, Cheung AM et al. Atypical Subtrochanteric and Diaphyseal Femoral Fractures: Second Report...
  • Lewiecki EM. Safety of long-term bisphosphonate therapy for the management of osteoporosis. Drugs 2011 16; 71(6): 791-814.
  • Girgis CM, Sher D,Seibel MJ. Atypical Femoral Fractures and Bisphosphonate Use. N Engl J Med 2010; 362: 1848-1849.
  • Yli-Kyyny T. Bisphosphonates and Atypical Fractures of Femur. J Osteop 2011.
  • http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm203891.htm. FDA Drug Safety Communication: Ongoing...
  • http://www.fda.gov/Drugs/DrugSafety/ucm229009.htm. FDA Drug Safety Communication: Safety updatefor osteoporosis drugs, bisphosphonates, and...
  • Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, and Pak CYC. Severely Suppressed Bone Turnover: A Potential Complication of AlendronateTherapy....
  • Pietrogrande L, Raimondo E. Teriparatide in thetreatment of non-unions: Scientific and clinicalevidences. Injury 2013; 44: S54–S57.
  • Weil YA1, Rivkin G, Safran O, Liebergall M, Foldes AJ. The outcome of surgically treated femur fractures associated with long-term bisphosphonate...
  • Issack PS. Bisphosphonate-Associated Subtrochanteric Femoral Fracture with Profound Proximal Cortical Thickening and Canal Narrowing Requiring...
  • Giannotti S1, Bottai V, Dell'Osso G, De Paola G, Ghilardi M, Guido G. Pseudoarthrosis in atypical femoral fracture: case report. Osteoporos...
  • Grady MK, Watson JT, Cannada LK. Treatment of Femoral Fracture Nonunion After Long-term Bisphosphonate Use. Orthopedics Jun2012, Vol. 35 Issue...
  • O'Neill BJ, O'hEireamhoin S, Morrissey DI, Keogh P. Implant failure caused by non-union of bisphosphonate-associated subtrochanteric...
  • Xue D, Li F, Chen G, Yan S, Pan Z. Do bisphosphonates affect bonehealing? A meta-analysis of randomized controlled trials. J Orthop Surg Res....