Report of successful application of the chipping technique in atypical femoral fracture prophylactic surgery

Treatment using intramedullary nail (IMN) is challenging for atypical femoral incomplete fractures with the bowed femur. Although IMN is the first choice for atypical femoral fractures, there is often a mismatch between the shape of the femur and the implant. Therefore, for prophylactic surgery of atypical femoral incomplete fracture we used IMN with a chipping technique, which is used for non-unions of the longitudinal fracture. We report a case of an 87-year-old woman who presented with bilateral thigh pain that lasted 3 months and gradually worsened. She had a medication history of bisphosphonates for 10 years. In addition, radiography showed severe curvature in her femurs, with radiolucent fracture lines in the diaphysis. We obtained good results by using IMN with the chipping technique. Thigh pain was promptly relieved postoperatively. Four months after surgery, each bone had fused without the need for additional treatment. The chipping technique in prevention surgery of atypical femoral fracture can eliminate the mismatch with the implant by grinding the limited lesion, including the radiolucent fracture line. Moreover, it promotes bone healing.