PMC6171208_01
Preoperative images of bilateral atypical femoral fractures (AFFs). (a) Bone scintigraphy showing increased uptake in both proximal femurs at follow-up before a left displaced AFF. (b) Radiography showing a left displaced AFF and a right incomplete AFF.
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After discontinuation of zoledronate, denosumab was used for 3 years until the detection of AFFs in both proximal femurs on the bone scintigraphy at 62 years of age (Figure 1(a)). She experienced a left displaced femoral subtrochanteric fracture after falling at the age of 63 years (Figure 1(b)). In addition, radiography of the fracture area exhibited a beak on the lateral side of the fracture site associated with cortical bone sclerosis, which was characteristic of an AFF (Figure 1(b)).
Postoperative images of bilateral atypical femoral fractures (AFFs). (a) Radiography after endoprosthetic reconstruction for the left displaced AFF. (b) Radiography after prophylactic intramedullary nailing for the right incomplete AFF.
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To achieve early weight bearing and avoid these issues, we performed endoprosthetic reconstruction (Zimmer Biomet, OSS Proximal Femur) on the seventh day after the injury (Figure 2(a)). After subsequent rehabilitation, prophylactic IMN was performed for the right incomplete AFF (Figure 2(b)).