PMC6742867_01
(a-c) Radiograph of right femur -complete diaphyseal fracture with transverse/short oblique configuration, medial spike, and hypertrophic lateral cortex without comminution.
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F1
On admission, the radiographic examination of right femur showed complete fracture at the diaphyseal level of transverse/short oblique configuration without comminution with a medial spike and concomitant hypertrophic lateral cortex (Fig. 1a, Fig. 1b, c).
Radiograph of the spine-multiple osteoporotic vertebral fractures with severe kyphosis.
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F2
Radiograph of the spine showed multiple osteoporotic vertebral fractures with severe kyphosis (Fig. 2).
(a and b) Post-operative radiograph -closed reduction and intramedullary fixation of the right femur.
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F3
Considering, AFF have been reported to occur commonly in subtrochanteric and diaphyseal region of the femur, the patient was treated with closed intramedullary nailing (Fig. 3a, Fig. 3b) and antiresorptive medications were stopped.
(a and b) 6 weeks follow-up radiograph - good visible callus formation.
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F4
At 6 weeks, radiograph showed good callus formation (Figs. 4a, b), she was started on weight-bearingwalking.
(a and b) Radiograph of left femur-lateral cortical hypertrophy with a lateral spike, suggestive of increased stress.
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F5
Radiograph of contralateral left femur revealed endosteal reaction and focal area of lateral cortex hypertrophy at the isthmic region (Figs. 5a, b).
Post-operative radiograph-insitu fixation with intramedullary nail.
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F6
Site- 2(diaphyseal); pain- 2(Mild); contralateral- 1(Complete); radiolucent line- 1(Focal change), and the total score - 6. She was admitted and treated with prophylactic insitu intramedullary nailing (Fig. 6).
(a and b) 6 weeks radiograph of left femur-resolved lateral spike suggesting offloading of the stress by the intramedullary nail.
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F7
At 6 weeks follow-up, the patient was relieved of the left-sided thigh pain and radiograph showed signs of healing (Fig. 7a, Fig. 7b).
(a and b) 1-yearradiograph of right femur-healed femur fracture.
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F8
Right-sided complete AFF had healed well as seen in 1 year follow-up radiograph (Figs. 8a, b) and patient walks with stick support.