Abstract

This is a case report of a surgical treatment of the non-union of an atypical femoral fracture (AFF), associated with prolonged bisphosphonate use. The case is one of a subtrochanteric non-union and implant failure, after an index procedure of a trochanteric entry-point-locked cephalomedullary nailing. The non-union fracture healed successfully by exchange of nail and autologous iliac crest bone graft and a bone morphogenic protein-7 (osteogenic protein-1, OP-1) supplementation. This case describes one of the surgical treatment options for treating non-union with implant failure in AFF treatments. The case suggests that the surgical management of bisphosphonate-related AFFs should be different from standard fracture treatment: for example involving a thicker and longer intramedullary (IM) nail, an autologous iliac crest bone graft, and use of bone morphogenic proteins.

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