Open Access Case Report Journal of Orthopaedics and Skeletal Medicine Volume 1 Issue 1 www.scienceinquest.com © All copy rights are reserved by Alistair M Bilateral Bisphosphonate Related Femoral Shaft Fractures; Is this a Surgical Emergency? Macey A * , Sciberras N, Gupta S and Hems T Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, United Kingdom * Corresponding Author: Macey A, Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, United Kingdom, Tel: 0141 201 1100, E-mail: Citation: Macey A, Sciberras N, Gupta S, Hems T (2017) Bilateral Bisphosphonate Related Femoral Shaft Fractures; Is this a Surgical Emergency? J Orthop Skeletal Med 1(1): 103 Introduction Bilateral femoral fractures related to bisphosphonates are rare. Evidence on how and when to fix them is lacking [1]. This case illustrates a successful treatment strategy of early definitive fixation after a short period of resuscitation. A brief review of bisphosphonate fractures in included. As the literature is sparse in relation to bilateral bisphosphonate fractures, in particular how and when to operate upon them, we have examined the evidence on higher energy bilateral femoral fractures to ascertain some guidance. Abstract Introduction: An 80 year old lady fell from standing sustaining bilateral fractures of the femora one year after stopping Alendronate treatment. Keywords: Femoral fracture; Bisphosphonates; Timing; Surgery Case Presentation: History, radiographic and histological features were indicative of bisphosphonate related fractures. Fixation overnight was considered, as there was concern over potential for ongoing blood loss, combined with the fact that one fracture was open. On the other hand, the patient had a type 1 respiratory failure and it was felt that reamed intramedullary femoral nailings could potentially precipitate a respiratory crisis. Conclusion: After a 12hour period of optimization, early definitive fixation with bilateral reamed intramedullary nails was achieved with no hypovolaemia or worsening pulmonary failure. A long period of rehabilitation was required but the patient is now mobile and the fractures healed. The timing of surgery in this unusual injury pattern is examined here along with a brief review of the literature. Early surgery, after a brief period of resuscitation, is preferable to emergency surgery for this unusual bilateral fracture pattern. Case presentation An 80 year old lady sustained bilateral femoral fractures following a trip on flat ground (Figure 1a and 1b). There were no preceding symptoms and no thigh pain prior to falling. No other injuries were sustained. On presentation, oxygen saturations on air were 92%, recovering to 100% on 15L oxygen. Bibasal fine crepetations could be heard at the lung bases. The patient was in fast atrial fibrillation but blood pressure was maintained at 154/80 mmHg. Both thighs were swollen and deformed; the right having a puncture wound of 1 cm diameter on the lateral aspect. Thomas splints were applied and antibiotic prophylaxis administered in accordance with the British Orthopaedic Association Standards for Trauma guideline on the management of open fractures of the lower limb. Neurovascular examination of the limbs was normal [2]. As the patient was warfarinised for atrial fibrillation and transient ischaemic attacks, vitamin K and Berriplex were administered. She had previously had a vertebral wedge fracture, metacarpal and metatarsal fractures. Received: June 12, 2017; Published: September 12, 2017