Femoral canal obliteration secondary to prolonged alendronate use: a case report.

Insufficiency fractures secondary to prolonged alendronate use is due to inhibition of osteoclastic activity and suppressed bone turnover. Complications of fracture fixation include non-union, mal-union, and difficulty in intramedullary nail insertion. We report a technical challenge in intramedullary nailing of an obliterated femoral canal in a patient on long-term bisphosphonate treatment. The fracture site was explored. The medullary canal was re-created by drilling. Patience and caution during drilling and reaming are necessary to avoid iatrogenic fractures.