Purpose
Atypical ulnar fracture (AUF) related to prolonged bisphosphonate therapy is a rare
complication. We propose diagnostic criteria of AUFs and present a treatment algorithm.
Methods
Twelve AUFs in 10 patients were studied. The diagnosis of AUF was based on the case
definition of atypical femoral fracture (AFF). We investigated clinical and radiographic
characteristics of AUFs according to major and minor features of AFFs, and modified
the case definition of an AFF to fit the characteristics of AUFs. All AUFs were treated
surgically. The radiographic union of fractures was investigated, and delayed fracture
healing was defined as a delay of 6 months or more.
Results
The average point at which AUFs occurred was at a point 35.1% along the proximal diaphysis
of the total ulnar length. All major features of AFFs were identified in the 12 AUFs.
Among the minor features, generalized cortical thickening was observed in 6 AUFs,
prodromal symptoms in 2 AUFs, bilateral involvement in 2 patients, and delayed fracture
healing in 10 AUFs (5 delayed union, 5 nonunion). Initially, 11 of 12 AUFs were treated
with plating, and 1 was treated with intramedullary nailing. Two nonunions were revised
with sclerotic bone resections, bone grafts, and plate fixation. Finally, union was
achieved in 9 AUFs.
Conclusions
The case definition of AFFs can be used for the diagnosis of AUFs, although some modifications
must be included in the case definition. Plating is useful in managing AUFs, although
sclerotic bone resections and bone grafts may be required. Atypical ulnar fractures
occurred in patients who took bisphosphonates longer than AFFs or those whose bisphosphonates
were discontinued a few years earlier. Therefore, physicians should be aware of AUFs
in those patients and, if necessary, perform a screening test to look for atypical
fractures in other bones.
Type of study/level of evidence
Diagnostic V.
Key Words
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Article info
Publication history
Published online: September 23, 2021
Accepted:
August 4,
2021
Received:
August 12,
2020
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
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© 2022 by the American Society for Surgery of the Hand. All rights reserved.
