Clin Osteol 2022; 27(2-3): 65-68
Insuficientná zlomenina ramienka lonovej kosti - "typická", alebo "atypická": kazuistikaKazuistiky
- 1 Oddelenie ortopédie, FNsP J. A. Reimana Prešov
- 2 II. ortopedicko-traumatologická klinika LF UK a UNB, Bratislava
Insuficientné zlomeniny vznikajú pri normálnej záťaži na patologicky oslabenú kosť, predovšetkým v dôsledku osteoporózy. Atypické zlomeniny femuru sú popísané ako komplikácia dlhodobého užívania bisfosfonátov. Vzhľadom k starnutiu populácie sa incidencia insuficientných fraktúr, ako aj atypických zlomenín femuru, zvyšuje. Rovnako problémom je ich včasná diagnostika, keďže na prvotnej natívnej RTG-snímke bývajú často prehliadnuté. Prezentujeme prípad pacientky, dlhodobo liečenej denosumabom, s atraumatickou zlomeninou dolného ramienka lonovej kosti. Vzhľadom k predĺženému kostnému hojeniu s neobvyklým obrazom hojenia uvažujeme nad dlhodobou antiresopčnou liečbou ako možnou príčinou vzniku zlomeniny ramienka lonovej kosti a faktorom ovplyvňujúcim hojenie insuficientnej fraktúry.
Klíčová slova: osteoporóza; bisfosfonáty; atypická zlomenina; insuficientná zlomenina
Insufficiency fracture of the pubic ramus - "typical" or "atypical": a case report
Insufficiency fractures occur in normal load on pathologically weak bone, as a result of osteoporosis. Atypical femoral fractures are well described complication of long term bisphosphonate use. With a growing geriatric population, the incidence of insufficiency fractures, as well as atypical femoral fractures, has increased. Also their early diagnostics is a problem, because they are often overlooked on first native X-ray. We present a case of patient, longterm treated with denosumab, who developed fracture of the pubic ramus. Because of delayed bone healing with unusual pattern we consider long-term anti-resorption therapy as a potentional cause of the pubic ramus fracture or factor affecting the healing of insufficiency fracture.
Keywords: bisphosphonates; osteoporosis; atypical fracture; insufficiency fracture
Vloženo: 29. červen 2022; Přijato: 30. červenec 2022; Zveřejněno: 11. prosinec 2022 Zobrazit citaci
Reference
- 1. Marshall RA, Mandell JC, Weaver MJ et al. Imaging Features and Management of Stress, Atypical, and Pathologic Fractures. Radiographics 2 018; 3 8(7): 2173-2192. Dostupné z DOI: <http://dx.doi.org/10.1148/rg.2018180073>.
- 2. O'Connor TJ, Cole PA. Pelvic Insufficiency Fractures. Geriatr Orthop Surg Rehabil 2 014; 5 (4):178-190. D ostupné z DOI: < http://dx.doi.org/10.1177/2151458514548895>.
- 3. Van Berkel D, Herschkovich O, Taylor Ret al. The truth behind the pubic rami fracture: identification of pelvic fragility fractures at a university teaching hospital. Clin Med (Lond) 2020; 20(Suppl 2): 113. Dostupné z DOI: <http://dx.doi.org/10.7861/clinmed.20-2-s113>.
- 4. Franekova L. Atypical femoral fractures - what´s new? Clinic Osteol 2021; 26(4): 191-199.
- 5. Cabarrus MC, Ambekar A, LuY et al. MRI and CT of insufficiency fractures of the pelvis and the proximal femur. AJR Am J Roentgenol 2008; 191(4): 995-1001. Dostupné z DOI: <http://dx.doi.org/10.2214/AJR.07.3714.>.
- 6. Patel V, Graves L, Lukert B. Pelvic fractures associated with longterm bisphosphonate therapy - case report. J Musculoskelet NeuronalInteract 2013; 13(2): 251-254.
- 7. Studer P, Suhm N, Zappe Bet al. Pubic rami fractures in the elderly - a neglected injury? Swiss Med Wkly 2013; 143: w13859. Dostupné z DOI: <http://dx.doi.org/10.4414/smw.2013.13859>.
- 8. Kloc P, Tomcovcik L, Kloc J. Bilateral pathological sub-trochanteric fracture in a long-term biphosphonate user. Acta Chir Orthop Traumatol Cech 2011; 78(1): 77-81.
- 9. Adams AL, Xue F, Chantra JQ et al. Sensitivity and specificity of radiographic characteristics in atypical femoral fractures. Osteoporos Int 2017; 28(1): 413-417. Dostupné z DOI: <http://dx.doi.org/10.1007/s00198-016-3809-y>.
- 10. LeBlanc ES, Rosales AG, Genant HK et al. Radiological criteria for atypical features of femur fractures: what we can learn when applied in a clinical study setting. Osteoporos Int 2019; 30(6): 1287-1295. Dostupné z DOI: <http://dx.doi.org/10.1007/s00198-019-04869-z>.