Bilateral atraumatic femoral fracture treated with humeral nail in a patient with prolonged hemodialysis

Authors

Keywords:

bilateral atraumatic femoral fracture, renal osteodystrophy, locked humeral nail.

Abstract

Introduction: Renal osteodystrophy, one of the complications of hemodialysis, causes pathological fractures, since, by affecting calcium metabolism, it stimulates bone resorption and leads to osteoporosis. However, bilateral atraumatic diaphyseal femoral fractures, equivalent to atypical femoral fractures, have not been reported in patients treated with prolonged hemodialysis.

Objective: To demonstrate the efficacy of the locked humeral intramedullary nail as a therapeutic alternative, when a pediatric femoral intramedullary nail is not available, in patients treated with prolonged hemodialysis.

Case report: The case of a 23-year-old woman with end-stage renal failure and prolonged hemodialysis treatment is reported. She presented renal osteodystrophy and was underweight. She suffered bilateral atraumatic atypical diaphyseal femoral fractures. A satisfactory result was obtained with the use of a locked humeral nail.

Conclusions: The locked humeral intramedullary nail is considered an effective alternative for atypical femoral fractures in underweight patients.

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Author Biography

Renán Estuardo Vargas Morales, Universidad Privada Antenor Orrego

Traumatólogo Ortopedista del Hospital Víctor Lazarte Echegaray de Trujillo. Docente de Cirugía I, Escuela de Medicina Humana, Universidad Privada Antenor Orrego. Doctor en Planificación y Gestión. Maestro en Docencia Universitaria.

References

Sridharan K. Chronic kidney disease mineral and bone disorder: A guide for general practice. Aust J Gen Pract. 2023;52(1-2). DOI: https://doi.org/10.31128/ajgp-03-22-6365

Zakaria S, Chin M, Yi M, Roselam M, Hassim M. Coincident bilateral atraumatic hip fracture in a young patient with renal osteodystrophy. Open J Orthop. 2020;10(11). DOI: https://doi.org/10.4236/ojo.2020.1011032

Andika G, Nugraha G, Sunaria I, Astawa P, Wiratnaya I, Maharjana M. Pathological fracture of subtrochanter femur, soft tissue infection along the fracture site, shaft femur bone cortex thickening and blastic lession on contralateral shaft femur due to renal osteodystrophy on the end stage renal disease patient: a case report. Int J Res Med Sci. 2020;8:3715-9. DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20204259

Hatano M, Kitajima I, Isawa K, Hirota Y, Suwabe T, Hoshino J, et al. Diaphyseal femoral fracture due to severe vitamin D3 deficiency and low parathyroid hormone levels on long-term hemodialysis: a case report. Arch Osteoporos. 2020;15:179. DOI: https://doi.org/10.1007%2Fs11657-020-00849-7

Tano A, Oh Y, Fukushima K, Kurosa Y, Wakabayashi Y, Fujita K, et al. Potential bone fragility of mid-shaft atypical femoral fracture: Biomechanical analysis by a CT-based nonlinear finite element method. Injury. 2019;50(11):1876-82. DOI: https://doi.org/10.1016/j.injury.2019.09.004

Oh Y, Yamamoto K, Yoshii T, Kitagawa M, Okawa A. Current concept of stress fractures with an additional category of atypical fractures: a perspective review with representative images. Ther Adv Endocrinol Metabol. 2021;12:1-8. DOI: https://doi.org/10.1177%2F20420188211049619

Jung I, Kim J. Differences in femur geometry and bone markers in atypical femur fractures and the general population. Sci Rep. 2021;11:24149. DOI: https://doi.org/10.1038/s41598-021-03603-2

Severyns M, Belaid D, Aubert K, Bouchoucha A, Germaneau A, Vendeuvre T. Biomechanical analysis of the correlation between mid-shaft atypical femoral fracture (AFF) and axial varus deformation. J Orthop Surg Res. 2022;17:165. DOI: https://doi.org/10.1186/s13018-022-03060-1

Alıç T, Güler C, Çalbıyık M, Hassa E. Which of the three different intramedullary nail designs is superior in the treatment of femoral shaft fractures? J Health Sci Med. 2023;6(2):467-75. DOI: https://doi.org/10.32322/jhsm.1227816

Falotico G, Cunza J, Ferreira G, Oliveira V, Oksman D, Arliani G. Fraturas atípicas do fêmur associadas ao uso crônico de bisfosfonatos: Uma série de casos de 66 pacientes. Rev Bras Ortop. 2022;57(5):851-5. DOI: https://doi.org/10.1055/s-0041-1726066

Park H, Kim H. Treatment of femoral shaft fracture with an interlocking humeral nail in older children and adolescents. Yonsei Med J. 2012;53(2):408-15. DOI: https://doi.org/10.3349/ymj.2012.53.2.408

Rosa N, Marta M, Vaz M, Tavares S, Simoes R, Magalhães F, et al. Intramedullary nailing biomechanics: Evolution and challenges. Proc Inst Mech Eng H. 2019;233(3):295-308. DOI: https://doi.org/10.1177/0954411919827044

Published

2024-11-28

How to Cite

1.
Vargas Morales RE, Zavaleta Alfaro RL, Lozano Peralta KY. Bilateral atraumatic femoral fracture treated with humeral nail in a patient with prolonged hemodialysis. Revista Cubana de Ortopedia y Traumatologí­a [Internet]. 2024 Nov. 28 [cited 2025 Feb. 2];38. Available from: https://revortopedia.sld.cu/index.php/revortopedia/article/view/785

Issue

Section

Presentación de casos

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