Rifrattura di femore in osteoporosi severa non trattata: descrizione di un caso

In orthopaedic practice, periprothesic fractures are gaining relevance. Their incidence after first implantation is 1.5% and they increase to 6% in revisions. However, their etiology is still uncertain, as evidenced by the present case report of a femoral periprosthetic re-fracture. A female 83-years-old patient, admitted to another hospital for a femoral subcapital fracture and treated with the implantation of an endoprosthesis, was discharged for a long rehabilitative period. After some time the patient had a new periprosthetic fracture, followed by prolonged bed rest due to a synthesis with long plate. Less than one year later she had her third femoral fracture of Vancouver type B1 involving the diaphysis between hip stem of the endoprosthesis and the plate implanted in the two previous occasions. During hospitalization at our institute bone turnover markers and vertebral DEXA revealed a severe poromalacic status characterized by high bone resorption and vitamin D3 deficiency related to secondary hyperparathyroidism. After surgery, in view of 3 months of wheel-chair and no weight-bearing, she started teriparatide, a bone anabolic agent, with daily calcium carbonate and vitamin D3 supplementation; 5 months after the intervention she walked on weight-bearing with crutches. At 2 years f.u. she is free from new fractures and lives and walks in autonomy with one crutch