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Bilateral atypical ulnar fractures occurring after long-term treatment with bisphosphonate for 7 years and with teriparatide for 2 years: a case report.
Breast Cancer Research and Treatment ( IF 3.8 ) Pub Date : 2020-09-10 , DOI: 10.1007/s00198-020-05618-3
Y Asano 1 , K Tajiri 1 , S Yagishita 1 , H Nakanishi 1 , T Ishii 1
Affiliation  

Most atypical fractures associated with the long-term treatment with bisphosphonates (BP) commonly develop in the femoral shaft or subtrochanteric region. We report a rare case of bilateral atypical ulnar fractures in an 86-year-old woman with osteoporosis who finished the treatment with teriparatide for 2 years after long-term treatment with BP. She slid down from an approximately 30-cm-tall seat and slightly contused her left elbow. Plain radiography revealed that both ulnae had a noncomminuted short oblique fracture with cortical thickening and sclerosis at the fracture site. Based on the clinical and radiological findings, she was diagnosed with bilateral atypical ulnar fractures. The fracture of the left ulna was completely displaced and treated surgically. On the other hand, since the right ulna was an incomplete fracture, it was treated conservatively. During surgery, drilling with Kirschner wire and curettage were performed in the osteosclerotic lesion, and an autologous cancellous bone graft was inserted from the ipsilateral olecranon. Bone union was achieved in both fractures at 1 year after surgery. There have been no reports regarding the development of atypical ulnar fractures occurring after the long-term treatment with BP and 2-year use of teriparatide, and the treatment strategies of such fractures have not been established. If teriparatide cannot be used after occurring atypical fractures, the use of low-intensity pulsed ultrasound (LIPUS) and subsequent treatment for osteoporosis are recommended for the bone union. In addition, the treatment of the osteosclerotic lesion and rigid internal fixation are required in surgery.



中文翻译:

长期用双膦酸盐治疗7年和特立帕肽治疗2年后发生的双侧非典型尺骨骨折:1例病例报告。

大多数与双膦酸盐(BP)长期治疗相关的非典型骨折通常发生在股骨干或转子下区域。我们报告了一个罕见的双侧非典型尺骨骨折病例,该病例为一例86岁的骨质疏松症患者,在长期接受BP治疗后2年完成了特立帕肽治疗。她从一个大约30厘米高的座椅上滑下来,略微挫伤了左肘。X线平片显示,尺骨均未发生粉碎性短斜折骨折,骨折部位皮质增厚,硬化。根据临床和放射学发现,她被诊断为双侧非典型尺骨骨折。左尺骨骨折完全移位并通过手术治疗。另一方面,由于右尺骨是不完全的骨折,它被保守地对待。在手术过程中,用克氏针进行钻探并刮除骨硬化病灶,并从同侧鹰嘴插入自体松质骨移植物。术后1年,两个骨折均实现骨结合。长期使用BP并使用特立帕肽治疗2年后,没有关于尺骨非典型骨折发展的报道,并且尚未建立此类骨折的治疗策略。如果在发生非典型骨折后不能使用特立帕肽,则建议使用低强度脉冲超声(LIPUS)并随后对骨质疏松症进行治疗。另外,在外科手术中需要治疗骨硬化性病变和刚性内固定。在骨硬化性病变中用克氏针进行钻孔和刮除术,并从同侧鹰嘴插入自体松质骨移植物。术后1年,两个骨折均实现骨结合。长期使用BP并使用特立帕肽治疗2年后,没有关于尺骨非典型骨折发展的报道,并且尚未建立此类骨折的治疗策略。如果在发生非典型骨折后不能使用特立帕肽,则建议使用低强度脉冲超声(LIPUS)并随后进行骨质疏松的治疗。另外,在外科手术中需要治疗骨硬化性病变和刚性内固定。在骨硬化性病变中用克氏针进行钻孔和刮除术,并从同侧鹰嘴插入自体松质骨移植物。术后1年,两个骨折均实现骨结合。长期使用BP并使用特立帕肽治疗2年后,没有关于尺骨非典型骨折发展的报道,并且尚未建立此类骨折的治疗策略。如果在发生非典型骨折后不能使用特立帕肽,则建议使用低强度脉冲超声(LIPUS)并随后进行骨质疏松的治疗。另外,在外科手术中需要治疗骨硬化性病变和刚性内固定。

更新日期:2020-09-10
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