title: A case of an atypical femoral fracture associated with bacterial biofilm--pathogen or bystander?
abstract: We report a case of an 86-year-old woman with an atypical femoral fracture (AFF) who was treated with intramedullary nailing followed by lateral femoral plating. She developed a second femoral shaft fracture distal to the intramedullary nail which required a second operation. Biopsy of the periosteum overlying the site of the initial proximal AFF was sent for pathogen analysis. Using the Ibis T5000 platform and the BAC plate assay, a polymicrobial infection was diagnosed consisting of Bifidobacterium subtile and Pseudomonas mendocina. This raises the possibility that bacterial infections may play some role in atypical fractures of the femur.
authors.affiliation: Departmant of Orthopaedics Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. tshowe@sgh.com.sg
authors.forename: T S
authors.initials: TS
authors.lastname: Howe
authors.forename: G D
authors.initials: GD
authors.lastname: Ehrlich
authors.forename: G
authors.initials: G
authors.lastname: Erlich
authors.forename: J S B
authors.initials: JS
authors.lastname: Koh
authors.forename: A C M
authors.initials: AC
authors.lastname: Ng
authors.forename: W
authors.initials: W
authors.lastname: Costerton
mesh_terms: D000369:Aged, 80 and over; D019386:Alendronate / Q000009:adverse effects; D039941:Bifidobacteriales Infections / Q000150:complications; D001644:Bifidobacterium / Q000502:physiology*; D018441:Biofilms; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001860:Bone Plates / Q000382:microbiology; D005260:Female; D005264:Femoral Fractures / Q000209:etiology* / Q000601:surgery; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D016459:Prosthesis-Related Infections / Q000150:complications; D011552:Pseudomonas Infections / Q000150:complications; D044203:Pseudomonas mendocina / Q000502:physiology*
chemical_list: D050071:Bone Density Conservation Agents; D019386:Alendronate