BMJ Case Reports 2017; doi:10.1136/bcr-2017-222129
  • Unusual presentation of more common disease/injury

Low-energy atypical femoral shaft and ipsilateral neck fracture: a rare association

  1. Alex Trompeter2
  1. 1Trauma & Orthopaedics, Kingston Hospital NHS Trust, Kingston upon Thames, UK
  2. 2Department of Trauma and Orthopaedics, St George’s University Hospital, London, UK
  1. Correspondence to Mr Chrisropher Peake, cmpeake{at}
  • Accepted 21 November 2017
  • Published 1 December 2017


This reports a case of a low-energy ipsilateral femoral shaft and neck fracture in a 69-year-old woman with vitamin D deficiency, who was taking long-term steroids and bisphosphonates. This is a fracture more commonly associated with a high-energy trauma. However, with an ageing global population and an increasing prevalence of bone insufficiency, we predict the incidence of this presentation to increase. Long-term bisphosphonate therapy has been associated with bone insufficiency and an increased rate of delayed union, adding to the complexity of management in these patients. There is currently no consensus regarding the choice of optimal implant or fixation technique to treat this challenging fracture pattern. We discuss the considerations that led to our management approach of a non-overlapping dynamic hip screw and femoral shaft plate construct which achieved uneventful bone healing and a good functional outcome within the first year of follow-up.


  • Contributors All the authors made individual and substantial contributions towards the writing of this case report.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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