Abstract
Bisphosphonates are widely used in the treatment of osteoporosis but predispose the
patient to the appearance of atypical fractures. The femoral subtrochanteric region
is usually affected, but other bones can be as well. Atypical tibia fractures in patients
with severe gonarthrosis is a therapeutic challenge. The present work reports the
case of an elderly patient with advanced gonarthrosis who presented atypical tibial
fracture. The patient made prolonged use of bisphosphonates for osteoporosis, presenting
with pain and functional limitation resulting from gonarthrosis, which progressed
to sudden pain in the right tibial metaphysis, preventing ambulation. The radiographs
showed bilateral severe arthrosis; marked varism; tibial and femoral medial erosion;
and fracture in the proximal third of the right tibial diaphysis. The fracture and
arthrosis on the right side were treated by osteosynthesis with blocked plaque and
total knee arthroplasty with posterior stabilization and fixed base. After physical
rehabilitation, significant improvement of pain and function was reported, independent
gait was reacquired and a range of motion of 0 to 100° was reached. After one year,
the radiographs showed fracture consolidation and satisfactory alignment of the lower
limbs' axes. The coexistence of severe arthrosis and atypical fracture made treatment
difficult. However, the result was satisfactory and the approach with simultaneous
osteosynthesis and arthroplasty proved to be adequate.
Keywords
bisphosphonate - bone fractures - arthroplasty - knee
