Bisphosphonates are the most commonly prescribed drugs to treat osteoporosis because they have been proposed to prevent bone loss. Nevertheless, in up to 0.1% of patients, long-term use may cause atypical stress or insufficiency femoral fractures. Bilateral femoral shaft fractures have been reported after long-term use of bisphosphonates; however, there is limited evidence of the effect of shor...

This article presents the history and development of as well as the results from the various techniques of vascularized bone grafting for the treatment of osteonecrosis (ON) of the femoral head. The authors have treated more than 2600 patients who had femoral head ON, using a vascularized fibular graft by way of an intraosseous approach. The results from this vast experience are summarized and ...

Femoral neck fractures and intertrochanteric fractures often occur in elderly patients, but simultaneous ipsilateral intra- and extracapsular hip fractures are rare. Either osteosynthesis or femoral head prosthesis is performed, but careful rehabilitation is necessary because of the instability of the fracture, even postoperatively. This article describes a 76-year-old man who fell and sustaine...

PURPOSE To assess the treatment outcome of revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures using a modular distally cemented stem. METHODS 22 men and 14 women (37 hips) aged 66 to 79 (mean, 70) years underwent revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures. The indication for surgery was periprosthetic fracture with stem loose...

Twenty-six patients with failed dynamic hip screw fixation of intertrochanteric fractures were included in this study. The mean age of the patients was 61 years (range, 38-84 years). Average limb shortening was 2.4 cm; 18 patients were treated with revision internal fixation and eight patients with prosthetic replacement. The decision depended on the physiological age of the patient, quality of...

Long term bisphosphonate use has been associated with "atypical" subtrochanteric and diaphyseal fractures of the femoral shaft. We are reporting a case of pelvic fractures in addition to atypical long bone fractures, in a patient with osteopenia treated with bisphosphonate for 8 years, and teriparatide for 2 years. After 5 years of bisphosphonate therapy the patient suffered an atraumatic fract...

PURPOSE People with dementia have poor mobility and discharge outcomes following hip fractures. The purpose of this study was to evaluate the clinical and radiological results of internal fixation of undisplaced femur neck fractures (Garden types 1 and 2) by proximal femoral nail antirotation (PFNA) in dementia patients. MATERIALS AND METHODS We studied retrospectively 19 patients with undisp...

A 64-year-old woman, with amyloid related kidney failure (On renal dialysis) had a bone scan because of pain in the right upper femur. The 99m Tc-MDP images revealed marked hepatic uptake. In addition, there was right proximal femoral concentration of radiotracer, which corresponded to a fracture site. As an added finding, the same femor demonstrated circumferential uptake at the lower po...

INTERTROCHANTERIC FRACTURES Approximately 50% of intertrochanteric fractures are stable and have minimal or no posteromedial comminution. The remaining 50% are unstable and have posteromedial instability and little resistance to varus deformity.1,4,5 Older rigid devices led to cutout or penetration of the nail as the fracture impacted. In the late 1960s, sliding devices were developed to allow ...

Bisphosphonates are the most widely prescribed pharmacologic treatment for osteoporosis and reduce fracture risk in postmenopausal women by up to 50%. However, in the past decade these drugs have been associated with atypical femoral fractures (AFFs), rare fractures with a transverse, brittle morphology. The unusual fracture morphology suggests that bisphosphonate treatment may impair toughenin...