{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:45:58Z","timestamp":1787755558359,"version":"build-2784847793"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Case:<\/jats:title>\n                    <jats:p>A 69-year-old woman with a history of breast cancer, on long-term antiresorptive medications, was treated with carbon fiber cephalomedullary nails for bilateral atypical femur fractures. Her thigh pain was presumed to be from metastatic lesions and was treated with radiation without standard imaging. The index procedure was complicated by a left nail fracture. The patient underwent exchange cephalomedullary nail fixation with plate augmentation. At 1 year, the patient was asymptomatic with radiographs demonstrating healing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This case highlights the importance of appropriate imaging in all patients with thigh pain on antiresorptive therapy and features an uncommon complication of carbon fiber cephalomedullary nail fixation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.cc.20.00182","type":"journal-article","created":{"date-parts":[[2020,9,21]],"date-time":"2020-09-21T15:38:47Z","timestamp":1600702727000},"page":"e20.00182-e20.00182","source":"Crossref","is-referenced-by-count":2,"title":["Bilateral Atypical Femur Fractures Complicated by Carbon Fiber Cephalomedullary Nail Fracture"],"prefix":"10.2106","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4144-6856","authenticated-orcid":false,"given":"J. Brett","family":"Goodloe","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1770-7892","authenticated-orcid":false,"given":"Sarah","family":"Toner","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4286-1058","authenticated-orcid":false,"given":"Alyssa","family":"Althoff","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7567-374X","authenticated-orcid":false,"given":"Leah","family":"Herzog","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8423-8355","authenticated-orcid":false,"given":"Stacey","family":"Rothwell","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3383-2343","authenticated-orcid":false,"given":"Kristoff","family":"Reid","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020]]},"reference":[{"issue":"4","key":"bib1-20230720","doi-asserted-by":"crossref","first-page":"e12490","DOI":"10.1111\/ecc.12490","article-title":"The use of bisphosphonates in the management of bone involvement from solid tumours and haematological malignancies\u2014a European survey","volume":"26","author":"Lebret","year":"2017","journal-title":"Eur J Cancer Care (Engl)."},{"issue":"suppl 3","key":"bib2-20230720","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1002\/cncr.11139","article-title":"Effectiveness and cost of bisphosphonate therapy in tumor bone disease","volume":"97","author":"Body","year":"2003","journal-title":"Cancer."},{"issue":"2","key":"bib3-20230720","doi-asserted-by":"crossref","first-page":"92","DOI":"10.3816\/SCT.2007.n.003","article-title":"Treatment of bone metastases and bone pain with bisphosphonates","volume":"4","author":"Lipton","year":"2007","journal-title":"Support Cancer Ther."},{"issue":"6","key":"bib4-20230720","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1200\/JCO.2009.24.5902","article-title":"Prevention of aromatase inhibitor\u2013induced bone loss using risedronate: the SABRE trial","volume":"28","author":"Poznak","year":"2010","journal-title":"J Clin Oncol."},{"issue":"7","key":"bib5-20230720","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1200\/JCO.2005.02.7102","article-title":"Zoledronic acid prevents cancer treatment\u2013induced bone loss in premenopausal women receiving adjuvant endocrine therapy for hormone-responsive breast cancer: a report from the Austrian Breast and Colorectal Cancer Study Group","volume":"25","author":"Gnant","year":"2007","journal-title":"J Clin Oncol."},{"key":"bib6-20230720","doi-asserted-by":"crossref","first-page":"287","DOI":"10.4137\/CMO.S8511","article-title":"Treatment-induced bone loss and fractures in cancer patients undergoing hormone ablation therapy: efficacy and safety of denosumab","volume":"6","author":"Lipton","year":"2012","journal-title":"Clin Med Insights Oncol."},{"issue":"12","key":"bib7-20230720","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1111\/ijcp.12022","article-title":"Denosumab: mechanism of action and clinical outcomes","volume":"66","author":"Hanley","year":"2012","journal-title":"Int J Clin Pract."},{"issue":"12","key":"bib8-20230720","first-page":"e6401","article-title":"Comparing the efficacy and safety of denosumab with bisphosphonates in increasing bone mineral density in patients with prostate cancer and breast cancer on antihormonal treatment","volume":"11","author":"Razaq","year":"2019","journal-title":"Cureus."},{"issue":"1","key":"bib9-20230720","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3109\/17453674.2013.854668","article-title":"Atypical femoral fractures bilaterally in a patient receiving denosumab","volume":"85","author":"Drampalos","year":"2014","journal-title":"Acta Orthop."},{"issue":"1","key":"bib10-20230720","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1186\/s12885-019-6236-6","article-title":"Atypical femoral fracture in patients with bone metastasis receiving denosumab therapy: a retrospective study and systematic review","volume":"19","author":"Takahashi","year":"2019","journal-title":"BMC Cancer."},{"issue":"1","key":"bib11-20230720","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/17453674.2013.859423","article-title":"Denosumab and atypical femoral fractures","volume":"85","author":"Aspenberg","year":"2014","journal-title":"Acta orthopaedica."},{"issue":"1","key":"bib12-20230720","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/jbmr.1998","article-title":"Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research","volume":"29","author":"Shane","year":"2014","journal-title":"J Bone Miner Res."},{"issue":"3","key":"bib13-20230720","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1080\/17453674.2016.1277412","article-title":"Atypical femoral fractures mimicking metastatic lesions in 2 patients taking denosumab","volume":"88","author":"Austin","year":"2017","journal-title":"Acta Orthop."},{"issue":"1018","key":"bib14-20230720","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1259\/bjr\/99102700","article-title":"Skeletal complications of bisphosphonate use: what the radiologist should know","volume":"85","author":"Haworth","year":"2012","journal-title":"Br J Radiol."},{"issue":"3","key":"bib15-20230720","doi-asserted-by":"crossref","first-page":"178","DOI":"10.4103\/0971-3026.107178","article-title":"Atypical femoral fractures related to bisphosphonate therapy","volume":"22","author":"Jain","year":"2012","journal-title":"Indian J Radiol Imaging."},{"key":"bib16-20230720","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/s13670-013-0045-6","article-title":"Atypical femoral fractures: an orthopaedic surgeon's perspective","volume":"2","author":"Jones","year":"2013","journal-title":"Curr Translational Geriatr Exp Gerontol Rep."},{"issue":"1","key":"bib17-20230720","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1186\/s12891-016-1086-8","article-title":"Management of atypical femoral fracture: a scoping review and comprehensive algorithm","volume":"17","author":"Toro","year":"2016","journal-title":"BMC Musculoskelet Disord."},{"key":"bib18-20230720","doi-asserted-by":"crossref","first-page":"2151459319864736","DOI":"10.1177\/2151459319864736","article-title":"A retrospective review on atypical femoral fracture: operative outcomes and the risk factors for failure","volume":"10","author":"Lai","year":"2019","journal-title":"Geriatr Orthopaedic Surg Rehabil."},{"issue":"9","key":"bib19-20230720","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1007\/s00256-015-2158-9","article-title":"Carbon fiber intramedullary nails reduce artifact in postoperative advanced imaging","volume":"44","author":"Zimel","year":"2015","journal-title":"Skeletal Radiol."},{"issue":"4","key":"bib20-20230720","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/j.injury.2010.10.012","article-title":"The invisible nail: a technique report of treatment of a pathological humerus fracture with a radiolucent intramedullary nail","volume":"42","author":"Collis","year":"2011","journal-title":"Injury."},{"issue":"12","key":"bib21-20230720","doi-asserted-by":"crossref","first-page":"825","DOI":"10.3928\/01477447-20141124-05","article-title":"Use of carbon-fiber-reinforced composite implants in orthopedic surgery","volume":"37","author":"Hak","year":"2014","journal-title":"Orthopedics."},{"issue":"3","key":"bib22-20230720","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1106\/BKLQ-E2YG-D2LA-RG3R","article-title":"Quantitative radiographic analysis of fiber reinforced polymer composites","volume":"15","author":"Baidya","year":"2001","journal-title":"J Biomater Appl."},{"issue":"1","key":"bib23-20230720","first-page":"23","article-title":"Utility of carbon fiber implants in orthopedic surgery: literature review","volume":"4","author":"Hillock","year":"2014","journal-title":"Reconstr Rev."},{"issue":"2","key":"bib24-20230720","doi-asserted-by":"crossref","first-page":"207","DOI":"10.2106\/00004623-201101190-00013","article-title":"Principles of biomechanics and biomaterials in orthopaedic surgery","volume":"93","author":"Golish","year":"2011","journal-title":"J Bone Joint Surg Am."},{"key":"bib25-20230720","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.jmbbm.2012.09.013","article-title":"Carbon fiber reinforced PEEK optima\u2014a composite material biomechanical properties and wear\/debris characteristics of CF-PEEK composites for orthopedic trauma implants","volume":"17","author":"Steinberg","year":"2013","journal-title":"J Mech Behav Biomed Mater."},{"issue":"3","key":"bib26-20230720","doi-asserted-by":"crossref","first-page":"e64","DOI":"10.4158\/EP12367.CR","article-title":"A case of an unusual subtrochanteric fracture in a patient receiving denosumab","volume":"19","author":"Paparodis","year":"2013","journal-title":"Endocr Pract."},{"issue":"1","key":"bib27-20230720","doi-asserted-by":"crossref","first-page":"6","DOI":"10.3109\/17453674.2014.885355","article-title":"Atypical fracture of the femur in a patient using denosumab\u2014a case report","volume":"85","author":"Schilcher","year":"2014","journal-title":"Acta Orthopaedica."},{"key":"bib28-20230720","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.bone.2013.12.027","article-title":"Bilateral atypical femoral fractures in a patient prescribed denosumab\u2014a case report","volume":"61","author":"Thompson","year":"2014","journal-title":"Bone."},{"issue":"1","key":"bib29-20230720","first-page":"1","article-title":"Denosumab and Atypical Femoral Fractures: A Scoping Literature Review","volume":"23","author":"Ismail","year":"2018","journal-title":"Trauma Monthly."},{"issue":"1","key":"bib30-20230720","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.maturitas.2013.06.004","article-title":"Denosumab and atypical femur fractures","volume":"76","author":"Cating-Cabral","year":"2013","journal-title":"Maturitas."},{"issue":"12","key":"bib31-20230720","doi-asserted-by":"crossref","first-page":"e585","DOI":"10.5435\/JAAOS-D-17-00483","article-title":"Fracture of a carbon fiber reinforced intramedullary femoral nail","volume":"27","author":"Vercio","year":"2019","journal-title":"J Am Acad Orthop Surg."}],"container-title":["JBJS Case Connector"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.20.00182","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:44:22Z","timestamp":1787751862000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.20.00182"}},"subtitle":["A Case Report"],"short-title":[],"issued":{"date-parts":[[2020]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.cc.20.00182","relation":{},"ISSN":["2160-3251"],"issn-type":[{"value":"2160-3251","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020]]}}}