PROPHYLACTIC INTRAMEDULLARY NAILING OF BISPHOSPHONATE RELATED BILATERAL SEQUENTIAL ATYPICAL FEMORAL SHAFT FRACTURE: A TREATMENT STRATEGY

Even though there are recent reports showing strong association between long term bisphosphonate therapy and atypical femoral shaft fractures, there are no well-defined guidelines regarding screening of these fractures and also regarding prevention of the same in a patient with bilateral sequential atypical femoral shaft fractures. We report our experience with two cases of bilateral, sequential, atypical femoral shaft fractures helpful in formulating guidelines for screening and management of these fractures. We also believe that prophylactic femoral intramedullary nailing with continuation of bisphosphonate therapy as a potential option for preventing the propagation of incomplete bilateral simultaneous/sequential atypical femoral shaft fractures into complete fracture.