title: Femoral insufficiency fractures in the elderly - excessive medial femoral bowing complicates intramedullary nailing.
abstract: OBJECTIVE
  The aim of this study was to evaluate the characteristics of low-energy femoral insufficiency fractures in elderly patients.
  
  
  METHODS
  The study retrospectively evaluated the clinical course of 4 patients with low-energy femoral shaft and subtrochanteric fractures admitted to our department between 2009 and 2011. Three patients had prior long-term alendronate therapy and one had prior glucocorticoid therapy.
  
  
  RESULTS
  There were 5 femoral shaft fractures, 2 incomplete shaft fractures, 2 subtrochanteric and 1 intertrochanteric fractures. All femoral shaft fractures had characteristic fracture patterns with thickened lateral cortices at the proximal fragment. Six femurs had excessive medial femoral bowing, which complicated intramedullary nailing. Additional fractures were seen on both femurs of one patient who had been primarily treated with short implants. A bifocal femoral fracture was seen in one femur. Union was achieved in all patients. Two patients were able to walk independently, one with a cane and one with double crutches.
  
  
  CONCLUSIONS
  We suggest the addition of another radiographic pattern of 'excessive medial femoral bowing' in low-energy femoral shaft fractures in elderly patients. This bowing complicates intramedullary nailing. Moreover, these insufficiency fractures should be fixed with long cephalomedullary nails.
authors.affiliation: Ankara Training and Research Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey. hakanozsoy@rocketmail.com.
authors.forename: Mehmet Hakan
authors.initials: MH
authors.lastname: Özsoy
authors.affiliation: Ankara Training and Research Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey.
authors.forename: Mehmet Atıf Erol
authors.initials: MA
authors.lastname: Aksekili
authors.affiliation: Ankara Training and Research Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey.
authors.forename: Onur
authors.initials: O
authors.lastname: Kızılay
authors.affiliation: Ankara Training and Research Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey.
authors.forename: Veysel Ercan
authors.initials: VE
authors.lastname: Dinçel
authors.affiliation: Ankara Training and Research Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey.
authors.forename: Nevres Hürriyet
authors.initials: NH
authors.lastname: Aydoğan
authors.affiliation: Ankara Numune Training and Research Hospital, Department of Radiology, Ankara, Turkey.
authors.forename: Arzu
authors.initials: A
authors.lastname: Ozsoy
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005269:Femur / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D017102:Fracture Healing / Q000502:physiology; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology
chemical_list: D000305:Adrenal Cortex Hormones; D019386:Alendronate