Acta Scientific Orthopaedics (ISSN: 2581-8635)

Case Report Volume 5 Issue 10

Atypical Femoral Stress Fracture with Uncommon Location and Mechanism of Injury: A Case Report

Kishan V Patel1, Mitesh Patel2*, Sunny Gupta2 and Irfan Chhipa2

1Department of Rehabilitation Medicine, New York University Langone Health, USA
2Department of Sports Medicine Orthopaedic, Rothman Orthopaedic Institute, USA

*Corresponding Author: Mitesh Patel, Department of Sports Medicine Orthopaedic, Rothman Orthopaedic Institute, USA.

Received: August 26, 2022; Published: September 19, 2022


Atypical femoral fractures (AFFs) typically present in patients predisposed to brittle bones or greater biomechanical stresses along the shaft of the femur. Risk factors include, Asian population, women, high body mass index, and users of bisphosphonates, glucocorticoids, and proton pump inhibitors. Most commonly the injury occurs in the proximal or middle portion, but few studies have documented distal femoral stress fractures.

This case illustrates a patient presenting with right lower extremity pain for over a month and difficulty ambulating for a few days. He initially had a negative conservative work up when the pain started. The patient lacked high energy trauma history and other predisposing conditions. After imaging with both X-ray and MRI, he was diagnosed with an occult transverse stress fracture of the distal femoral diametaphysis. He was treated conservatively with non-weight bearing to the right lower extremity for 6 weeks. On follow up, his fracture healed well and clinically the patient was able to return to his daily activities.

This report emphasizes a unique fracture mechanism and location to the limited evidence of AFFs. The case urges clinicians to consider ordering additional imaging for patients if the provider has a high clinical suspicion of fractures. A comprehensive history is warranted for the case of occult fractures as knowledge of risk factors can help diagnostic accuracy and improve patient care.

Keywords: Atypical Femoral Fractures (AFFs); Distal Diametaphysis; MRI; Fall; Non-Weight Bearing


  1. Larsen., et al. “The enigma of atypical femoral fractures: A summary of current knowledge”. EFORT Open Reviews 3.9 (2018): 494-500.
  2. Donnelly Eve., et al. “Atypical femoral fractures: epidemiology, etiology, and patient management”. Current Opinion in Supportive and Palliative Care 6.3 (2012): 348-354.
  3. Kottmeier Stephen. “Distal Femur (Thighbone) Fractures of the Knee - Orthoinfo - Aaos”. Edited by Stuart J Fischer and Brett Crist, OrthoInfo, American Academy of Orthopaedic Surgeons (2011).
  4. Jaimes Camilo., et al. “Taking the stress out of evaluating stress injuries in children”. Radiographics: A Review Publication of the Radiological Society of North America, Inc 32.2 (2012): 537-555.
  5. Lim SJ., et al. “Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study”. Osteoporosis International: A Journal Established as Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 29.11 (2018): 2427-2435.
  6. Soh Hsiu Hsien., et al. “Atypical fractures of the femur: effect of anterolateral bowing of the femur on fracture location”. Archives of Orthopaedic and Trauma Surgery 135.11 (2015): 1485-1490.
  7. Hyodo Kojiro., et al. “Location of fractures and the characteristics of patients with atypical femoral fractures: analyses of 38 Japanese cases”. Journal of Bone and Mineral Metabolism 35.2 (2017): 209-214.
  8. Jarraya Mohamed., et al. “Radiographically occult and subtle fractures: a pictorial review”. Radiology Research and Practice 2013 (2013): 370169.
  9. Zheng N., et al. “Atypical femoral fractures and current management”. Journal of Orthopaedic Translation 7 (2016): 7-22.


Citation: Mitesh Patel., et al. “Atypical Femoral Stress Fracture with Uncommon Location and Mechanism of Injury: A Case Report".Acta Scientific Orthopaedics 5.10 (2022): 48-51.


Copyright: © 2022 Mitesh Patel., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate33%
Acceptance to publication20-30 days

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is May 20, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US