Bilateral Simultaneous Atypical Femoral Fracture: A Case Report
Abstract
We report a rare case of bilateral subtrochanteric femoral fracture related to prolonged treatment with Alendr onate. Bisphosphonates are the most common drugs used for treatment of osteoporosis and prevention of the risk of osteoporosis-related fractures. Atypical femoral fractures (AFF) have been reported in patients who have been on long term treatment with bisphosphona te especially Alendr onate. our case was a 68- year- old woman who sustained bilateral subtroc- hanteric femoral fracture after a simple falling down. She had a past medical history of osteoporosis and had been on treatment with alendronate for 5 years. Radiographs showed bilateral fractures in femur subtrochanteric area. We decided to use double plating technique and we used angled blade plate and locking plate (LCP). Alendronate was discontinued and Teriparatide was started. Careful evaluation of hip or thigh pain in patients who are on prolonged courses of bisphosphonates is essential. Our method of fixation with double plating can be used in pa tients with poor bone quality.
[1] Fischer S, Kapinos KA, Mulcahy A, Pinto L, Hayden O, Barron R. Estimating the long-term functional burden of osteoporosis- related fractures. Osteoporos Int. 2017 Oct;28(10):2843-2851. https://doi.org/10.1007/s00198-017-4110-4 PMID: 28647804
[2] Pazianas M and Abrahamsen B. Safety of bisphosphonates.Bone 2011; 49: 103–110. https://doi.org/10.1016/j.bone.2011.01.003
[3] Stevenson M, JonesML, De Nigris E, Brewer N, Davis S, Oakley J.A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis. Health Technol Assess. 2005;9(22):1–16. https://doi. org/10.3310/hta9220
[4] Edwards BJ, Bunta AD, Lane J, Odvina C, Rao DS, Raisch DW, et al. Bisphosphonates and nonhealing femoral fractures: analysis of the FDA Adverse Event Reporting System (FAERS) and international safety efforts: a systematic review from the Research on Adverse Drug Events And Reports (RADAR) project. J Bone Joint Surg Am. 2013;95(4):297–307. https://doi. org/10.2106/JBJS.K.01181
[5] Khosla S, Bilezikian JP, Dempster DW, Lewiecki EM, Miller PD, Neer RM, et al. Benefits and risks of bisphosphonate therapy for osteoporosis. J Clin Endocrinol Metab. 2012;97(7):2272–82. https://doi.org/10.1210/jc.2012-1027
[6] Kim JE, Yun M, Lim SK, Rhee Y. Concurrent bisphosphonaterelated bilateral atypical subtrochanteric fractures and osteonecrosis of the jaw on bone scintigraphy. Clin Nucl Med. 2015;40(5):450–2. https://doi.org/10.1097/RLU.0000000000000746
[7] Crandall CJ, Newberry SJ, Diamant A, LimYW, GelladWF, Booth MJ, et al. Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review. Ann InternMed. 2014;161(10):711–23. https://doi. org/10.7326/M14-0317
[8] Bronson WH, Kaye ID, Egol KA. Atypical femur fractures: a review. Curr Osteoporos Rep. 2014;12(4):446–53. https://doi. org/10.1007/s11914-014-0239-7
[9] Dunn RL, Bird ML, Conway SE, Stratton MA. Use of bisphosphonates in older adults: how long is long enough? Consult Pharm. 2013;28(1):39–57. https://doi.org/10.4140/ TCP.n.2013.39
[10] Rizzoli R, Akesson K, Bouxsein M, Kanis JA, Napoli N, Papapoulos S, et al. Subtrochanteric fractures after long-term treatment with bisphosphonates: a European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, and International Osteoporosis Foundation Working Group Report. Osteoporos Int. 2011;22(2):373–90. https://doi.org/10.1007/ s00198-010-1453-5
[11] Lim SJ, Yeo I, Yoon PW, Yoo JJ, Rhyu KH, Han SB, Lee WS, Song JH, Min BW, Park YS. Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study. Osteoporos Int. 2018 Nov;29(11):2427-2435. https://doi. org/10.1007/s00198-018-4640-4 PMID: 30039251
[12] Dell R, Greene D. A proposal for an atypical femur fracture treatment and prevention clinical practice guideline. Osteoporos Int. 2018 Jun;29(6):1277-1283. https://doi. org/10.1007/s00198-018-4506-9 PMID: 29675745
[13] Whitaker M, Guo J, Kehoe T, Benson G. Bisphosphonates for osteoporosis—where do we go from here? N Engl J Med. 2012;366(22):2048–51. https://doi.org/10.1056/ NEJMp1202619
[14] Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY (2005) Severely suppressed bone turnover: a potential compli- cation of alendronate therapy. J Clin Endocrinol Metab 90:1294– 1301. https://doi.org/10.1210/jc.2004-0952
[15] Yeh WL, Su CY, Chang CW, Chen CH, Fu TS, Chen LH, Lin TY. Surgical outcome of atypical subtrochanteric and femoral fracture related to bisphosphonates use in osteoporotic patients with or without teriparatide treatment. BMC Musculoskelet Disord. 2017 Dec 13;18(1):527. https://doi. org/10.1186/s12891-017-1878-5 PMID: 29237448
[16] Dell RM, Adams AL, Greene DF, Funahashi TT, Silverman SL, Eisemon EO, et al. Incidence of atypical nontraumatic diaphyseal fractures of the femur. J Bone Miner Res. 2012;27(12):2544– 50. https://doi.org/10.1002/jbmr.1719
[17] Neviaser AS, Lane JM, Lenart BA, Edobor-Osula F, Lorich DG. Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma. 2008;22(5):346–50. https:// doi.org/10.1097/BOT.0b013e318172841c
[18] Goh SK, Yang KY, Koh JS, Wong MK, Chua SY, Chua DT, et al. Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution. J Bone Joint Surg Br. 2007;89(3):349–53. https://doi.org/10.1302/0301- 620X.89B3.18146
[19] Black DM, Kelly MP, Genant HK, Palermo L, Eastell R, Bucci- Rechtweg C, et al. Bisphosphonates and fractures of the subtrochanteric or diaphyseal femur. N Engl J Med. 2010;362(19): 1761–71. https://doi.org/10.1056/ NEJMoa1001086
[20] Gedmintas L, Solomon DH, Kim SC. Bisphosphonates and risk of subtrochanteric, femoral shaft, and atypical femur fracture: a systematic review and meta-analysis. J Bone Miner Res. 2013;28(8):1729–37. https://doi.org/10.1002/jbmr.1893
[21] Drake MT, Clarke BL, Khosla S (2008) Bisphosphonates: mecha- nism of action and role in clinical practice. Mayo Clin Proc 83: 1032–1045. https://doi.org/10.4065/83.9.1032
[22] Hoer A, Seidlitz C, Gothe H, Schiffhorst G, Olson M, Hadji P, Haussler B (2009) Influence on persistence and adherence with oral bisphosphonates on fracture rates in osteoporosis. Patient Prefer Adherence 3:25–30. https://doi.org/10.2147/PPA.S4673
[23] Bubbear JS. Atypical femur fractures in patients treated with bisphosphonates: identification, management, and prevention. Rambam Maimonides Med J. 2016; 7(4). doi: 10.5041/ RMMJ.10259. https://doi.org/10.5041/RMMJ.10259
[24] Geissler JR, Bajaj D, Fritton JC. American Society of Biomechanics Journal of Biomechanics Award 2013: cortical bone tissue mechanical quality and biological mechanisms possibly underlying atypical fractures. J Biomech. 2015; 48(6): 883-94. https://doi.org/10.1016/j.jbiomech.2015.01.032
[25] Saita Y, Ishijima M, Kaneko K. Atypical femoral fractures and bisphosphonate use: current evidence and clinical implications. Ther Adv Chronic Dis. 2015; 6(4): 185-93. https:// doi.org/10.1177/2040622315584114
[26] Takemoto RC, McLaurin TM, Tejwani N, Egol KA. Evolution of atypical femur fractures and the association with bisphosphonates. Bull Hosp Jt Dis (2013). 2014; 72(1): 104-9.
[27] Schilcher J, Koeppen V, Aspenberg P, Michaelsson K. Risk of atypical femoral fracture during and after bisphosphonate use. N Engl J Med. 2014;371(10):974. https://doi.org/10.1056/ NEJMc1403799
[28] Lockwood M, Banderudrappagari R, Suva LJ, Mak- houl I. Atypical femoral fractures from bisphosphonate in cancer patients-Review. J Bone Oncol. 2019; 18:100259. https://doi. org/10.1016/j.jbo.2019.100259
[29] Lo JC, Hui RL, Grimsrud CD, Chandra M, Neugebauer RS, Gon- zalez JR, Budayr A, Lau G, Ettinger B (2016) The association of race/ ethnicity and risk of atypical femur fracture among older women receiving oral bisphosphonate therapy. Bone 85:142–147. https:// doi.org/10.1016/j.bone.2016.01.002
[30] Shane E, Burr D, Abrahamsen B, Adler RA, Brown TD, Cheung AM, Cosman F, Curtis JR, Dell R, Dempster DW, Ebeling PR, Einhorn TA, Genant HK, Geusens P, Klaushofer K, Lane JM, McKiernan F, McKinney R, Ng A, Nieves J, O’Keefe R, Papapou- los S, Howe TS, van der Meulen MC, Weinstein RS, Whyte MP (2014) Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 29:1–23. https://doi.org/10.1002/ jbmr.1998
[31] Majima T, Komatsu Y, Fukao A, Ninomiya K, Matsumura T, Nakao K. Short-term effects of atorvastatin on bone turnover in male patients with hypercholesterolemia. Endocr J. 2007;54(1):145– 51. https://doi.org/10.1507/endocrj.K06-127
[32] Cleto-Zepeda G, Durán-Martínez N, Tena-Sanabria ME. Atypical femoral fracture, case report and literature review. Acta Ortop Mex. 2019 Jan-Feb;33(1):39-41. English. PMID: 31480125
[33] Hagino H, Endo N, Yamamoto T, Harada A, Iwamoto J, Kondo N, Mashiba T, Mori S, Nakamura J, Ohtori S, Sakai A, Takada J, Kato Y. Treatment status and radiographic features of patients with atypical femoral fractures. J Orthop Sci. 2018 Mar;23(2):316-320. https://doi.org/10.1016/j.jos.2017.10.008 PMID: 29146093
[34] Rosenberg ZS, La Rocca VR, Chan SS, Babb J, Akyol Y, Rybak LD, et al. Bisphosphonate-related complete atypical subtrochanteric femoral fractures: diagnostic utility of radiography. AJR Am J Roentgenol. 2011;197(4):954–60. https://doi.org/10.2214/ AJR.10.6262
[35] Kwek EB, Goh SK, Koh JS, Png MA, Howe TS. An emerging pattern of subtrochanteric stress fractures: a long-term complication of alendronate therapy? Injury. 2008;39(2):224–31. https://doi. org/10.1016/j.injury.2007.08.036
[36] Caeiro-Rey JR, Etxebarria-Foronda I, Mesa-Ramos M. Fracturas atípicas relacionadas con el uso prolongado de bifosfonatos. Estado de la situación. Rev Esp Cir Ortop Traumatol. 2011; 55(5): 392-40. https://doi.org/10.1016/j.recot.2011.05.002
[37] Schneider P, Wall M, Brown J, Cheung A, Harvey E, Morin S. Atypical femur fractures: a survey of current practices in orthopedic surgery. Osteoporos Int. 2017; 28(11):3271-6. https://doi.org/10.1007/s00198-017-4155-4
[38] Kharazmi, M., Michaëlsson, K., Schilcher, J. et al. A Genome- Wide Association Study of Bisphosphonate-Associated Atypical Femoral Fracture. Calcif Tissue Int 105, 51–67 (2019). https:// doi.org/10.1007/s00223-019-00546-9
[39] Im GI, Lee SH. Effect of teriparatide on healing of atypical femoral fractures: a systemic review. J Bone Metab. 2015; 22(4): 183-9. https://doi.org/10.11005/jbm.2015.22.4.183
[40] Ghaffari S, Razavipour M, Mohammad Amini P. Atypical Femoral Fracture in McCune-Albright Syndrome. Journal of Research in Orthopedic Science. 2020; 7(3):147-152. https:// doi.org/10.32598/JROSJ.7.3.711.1
[41] Robinson C, Collins MT, Boyce AM. Fibrous dysplasia/ McCune- Albright syndrome: Clinical and translational perspectives. Curr Osteoporos Rep. 2016; 14(5):178-86. https://doi.org/10.1007/ s11914-016-0317-0
[2] Pazianas M and Abrahamsen B. Safety of bisphosphonates.Bone 2011; 49: 103–110. https://doi.org/10.1016/j.bone.2011.01.003
[3] Stevenson M, JonesML, De Nigris E, Brewer N, Davis S, Oakley J.A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis. Health Technol Assess. 2005;9(22):1–16. https://doi. org/10.3310/hta9220
[4] Edwards BJ, Bunta AD, Lane J, Odvina C, Rao DS, Raisch DW, et al. Bisphosphonates and nonhealing femoral fractures: analysis of the FDA Adverse Event Reporting System (FAERS) and international safety efforts: a systematic review from the Research on Adverse Drug Events And Reports (RADAR) project. J Bone Joint Surg Am. 2013;95(4):297–307. https://doi. org/10.2106/JBJS.K.01181
[5] Khosla S, Bilezikian JP, Dempster DW, Lewiecki EM, Miller PD, Neer RM, et al. Benefits and risks of bisphosphonate therapy for osteoporosis. J Clin Endocrinol Metab. 2012;97(7):2272–82. https://doi.org/10.1210/jc.2012-1027
[6] Kim JE, Yun M, Lim SK, Rhee Y. Concurrent bisphosphonaterelated bilateral atypical subtrochanteric fractures and osteonecrosis of the jaw on bone scintigraphy. Clin Nucl Med. 2015;40(5):450–2. https://doi.org/10.1097/RLU.0000000000000746
[7] Crandall CJ, Newberry SJ, Diamant A, LimYW, GelladWF, Booth MJ, et al. Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review. Ann InternMed. 2014;161(10):711–23. https://doi. org/10.7326/M14-0317
[8] Bronson WH, Kaye ID, Egol KA. Atypical femur fractures: a review. Curr Osteoporos Rep. 2014;12(4):446–53. https://doi. org/10.1007/s11914-014-0239-7
[9] Dunn RL, Bird ML, Conway SE, Stratton MA. Use of bisphosphonates in older adults: how long is long enough? Consult Pharm. 2013;28(1):39–57. https://doi.org/10.4140/ TCP.n.2013.39
[10] Rizzoli R, Akesson K, Bouxsein M, Kanis JA, Napoli N, Papapoulos S, et al. Subtrochanteric fractures after long-term treatment with bisphosphonates: a European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, and International Osteoporosis Foundation Working Group Report. Osteoporos Int. 2011;22(2):373–90. https://doi.org/10.1007/ s00198-010-1453-5
[11] Lim SJ, Yeo I, Yoon PW, Yoo JJ, Rhyu KH, Han SB, Lee WS, Song JH, Min BW, Park YS. Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study. Osteoporos Int. 2018 Nov;29(11):2427-2435. https://doi. org/10.1007/s00198-018-4640-4 PMID: 30039251
[12] Dell R, Greene D. A proposal for an atypical femur fracture treatment and prevention clinical practice guideline. Osteoporos Int. 2018 Jun;29(6):1277-1283. https://doi. org/10.1007/s00198-018-4506-9 PMID: 29675745
[13] Whitaker M, Guo J, Kehoe T, Benson G. Bisphosphonates for osteoporosis—where do we go from here? N Engl J Med. 2012;366(22):2048–51. https://doi.org/10.1056/ NEJMp1202619
[14] Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY (2005) Severely suppressed bone turnover: a potential compli- cation of alendronate therapy. J Clin Endocrinol Metab 90:1294– 1301. https://doi.org/10.1210/jc.2004-0952
[15] Yeh WL, Su CY, Chang CW, Chen CH, Fu TS, Chen LH, Lin TY. Surgical outcome of atypical subtrochanteric and femoral fracture related to bisphosphonates use in osteoporotic patients with or without teriparatide treatment. BMC Musculoskelet Disord. 2017 Dec 13;18(1):527. https://doi. org/10.1186/s12891-017-1878-5 PMID: 29237448
[16] Dell RM, Adams AL, Greene DF, Funahashi TT, Silverman SL, Eisemon EO, et al. Incidence of atypical nontraumatic diaphyseal fractures of the femur. J Bone Miner Res. 2012;27(12):2544– 50. https://doi.org/10.1002/jbmr.1719
[17] Neviaser AS, Lane JM, Lenart BA, Edobor-Osula F, Lorich DG. Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma. 2008;22(5):346–50. https:// doi.org/10.1097/BOT.0b013e318172841c
[18] Goh SK, Yang KY, Koh JS, Wong MK, Chua SY, Chua DT, et al. Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution. J Bone Joint Surg Br. 2007;89(3):349–53. https://doi.org/10.1302/0301- 620X.89B3.18146
[19] Black DM, Kelly MP, Genant HK, Palermo L, Eastell R, Bucci- Rechtweg C, et al. Bisphosphonates and fractures of the subtrochanteric or diaphyseal femur. N Engl J Med. 2010;362(19): 1761–71. https://doi.org/10.1056/ NEJMoa1001086
[20] Gedmintas L, Solomon DH, Kim SC. Bisphosphonates and risk of subtrochanteric, femoral shaft, and atypical femur fracture: a systematic review and meta-analysis. J Bone Miner Res. 2013;28(8):1729–37. https://doi.org/10.1002/jbmr.1893
[21] Drake MT, Clarke BL, Khosla S (2008) Bisphosphonates: mecha- nism of action and role in clinical practice. Mayo Clin Proc 83: 1032–1045. https://doi.org/10.4065/83.9.1032
[22] Hoer A, Seidlitz C, Gothe H, Schiffhorst G, Olson M, Hadji P, Haussler B (2009) Influence on persistence and adherence with oral bisphosphonates on fracture rates in osteoporosis. Patient Prefer Adherence 3:25–30. https://doi.org/10.2147/PPA.S4673
[23] Bubbear JS. Atypical femur fractures in patients treated with bisphosphonates: identification, management, and prevention. Rambam Maimonides Med J. 2016; 7(4). doi: 10.5041/ RMMJ.10259. https://doi.org/10.5041/RMMJ.10259
[24] Geissler JR, Bajaj D, Fritton JC. American Society of Biomechanics Journal of Biomechanics Award 2013: cortical bone tissue mechanical quality and biological mechanisms possibly underlying atypical fractures. J Biomech. 2015; 48(6): 883-94. https://doi.org/10.1016/j.jbiomech.2015.01.032
[25] Saita Y, Ishijima M, Kaneko K. Atypical femoral fractures and bisphosphonate use: current evidence and clinical implications. Ther Adv Chronic Dis. 2015; 6(4): 185-93. https:// doi.org/10.1177/2040622315584114
[26] Takemoto RC, McLaurin TM, Tejwani N, Egol KA. Evolution of atypical femur fractures and the association with bisphosphonates. Bull Hosp Jt Dis (2013). 2014; 72(1): 104-9.
[27] Schilcher J, Koeppen V, Aspenberg P, Michaelsson K. Risk of atypical femoral fracture during and after bisphosphonate use. N Engl J Med. 2014;371(10):974. https://doi.org/10.1056/ NEJMc1403799
[28] Lockwood M, Banderudrappagari R, Suva LJ, Mak- houl I. Atypical femoral fractures from bisphosphonate in cancer patients-Review. J Bone Oncol. 2019; 18:100259. https://doi. org/10.1016/j.jbo.2019.100259
[29] Lo JC, Hui RL, Grimsrud CD, Chandra M, Neugebauer RS, Gon- zalez JR, Budayr A, Lau G, Ettinger B (2016) The association of race/ ethnicity and risk of atypical femur fracture among older women receiving oral bisphosphonate therapy. Bone 85:142–147. https:// doi.org/10.1016/j.bone.2016.01.002
[30] Shane E, Burr D, Abrahamsen B, Adler RA, Brown TD, Cheung AM, Cosman F, Curtis JR, Dell R, Dempster DW, Ebeling PR, Einhorn TA, Genant HK, Geusens P, Klaushofer K, Lane JM, McKiernan F, McKinney R, Ng A, Nieves J, O’Keefe R, Papapou- los S, Howe TS, van der Meulen MC, Weinstein RS, Whyte MP (2014) Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 29:1–23. https://doi.org/10.1002/ jbmr.1998
[31] Majima T, Komatsu Y, Fukao A, Ninomiya K, Matsumura T, Nakao K. Short-term effects of atorvastatin on bone turnover in male patients with hypercholesterolemia. Endocr J. 2007;54(1):145– 51. https://doi.org/10.1507/endocrj.K06-127
[32] Cleto-Zepeda G, Durán-Martínez N, Tena-Sanabria ME. Atypical femoral fracture, case report and literature review. Acta Ortop Mex. 2019 Jan-Feb;33(1):39-41. English. PMID: 31480125
[33] Hagino H, Endo N, Yamamoto T, Harada A, Iwamoto J, Kondo N, Mashiba T, Mori S, Nakamura J, Ohtori S, Sakai A, Takada J, Kato Y. Treatment status and radiographic features of patients with atypical femoral fractures. J Orthop Sci. 2018 Mar;23(2):316-320. https://doi.org/10.1016/j.jos.2017.10.008 PMID: 29146093
[34] Rosenberg ZS, La Rocca VR, Chan SS, Babb J, Akyol Y, Rybak LD, et al. Bisphosphonate-related complete atypical subtrochanteric femoral fractures: diagnostic utility of radiography. AJR Am J Roentgenol. 2011;197(4):954–60. https://doi.org/10.2214/ AJR.10.6262
[35] Kwek EB, Goh SK, Koh JS, Png MA, Howe TS. An emerging pattern of subtrochanteric stress fractures: a long-term complication of alendronate therapy? Injury. 2008;39(2):224–31. https://doi. org/10.1016/j.injury.2007.08.036
[36] Caeiro-Rey JR, Etxebarria-Foronda I, Mesa-Ramos M. Fracturas atípicas relacionadas con el uso prolongado de bifosfonatos. Estado de la situación. Rev Esp Cir Ortop Traumatol. 2011; 55(5): 392-40. https://doi.org/10.1016/j.recot.2011.05.002
[37] Schneider P, Wall M, Brown J, Cheung A, Harvey E, Morin S. Atypical femur fractures: a survey of current practices in orthopedic surgery. Osteoporos Int. 2017; 28(11):3271-6. https://doi.org/10.1007/s00198-017-4155-4
[38] Kharazmi, M., Michaëlsson, K., Schilcher, J. et al. A Genome- Wide Association Study of Bisphosphonate-Associated Atypical Femoral Fracture. Calcif Tissue Int 105, 51–67 (2019). https:// doi.org/10.1007/s00223-019-00546-9
[39] Im GI, Lee SH. Effect of teriparatide on healing of atypical femoral fractures: a systemic review. J Bone Metab. 2015; 22(4): 183-9. https://doi.org/10.11005/jbm.2015.22.4.183
[40] Ghaffari S, Razavipour M, Mohammad Amini P. Atypical Femoral Fracture in McCune-Albright Syndrome. Journal of Research in Orthopedic Science. 2020; 7(3):147-152. https:// doi.org/10.32598/JROSJ.7.3.711.1
[41] Robinson C, Collins MT, Boyce AM. Fibrous dysplasia/ McCune- Albright syndrome: Clinical and translational perspectives. Curr Osteoporos Rep. 2016; 14(5):178-86. https://doi.org/10.1007/ s11914-016-0317-0
| Files | ||
| Issue | Vol 7 No 2 (2022): March-April | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v7i2.10785 | |
| Keywords | ||
| Biphosphonate Atypical femural fracture Angle blade plate | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Ghaffari S, Razavipour M, Fateh S. Bilateral Simultaneous Atypical Femoral Fracture: A Case Report. CRCP. 2022;7(2):68-74.
