University of Missouri Columbia, Missouri, United States
Objective: Chronic myelogenous leukemia (CML) is a hematologic malignancy primarily affecting adults, characterized by the presence of the Philadelphia chromosome. Imatinib, a tyrosine kinase inhibitor, has revolutionized CML treatment but poses challenges, including its impact on bone metabolism.
Methods: We present the case of a 17-year-old female with CML on chronic Imatinib therapy who developed an atypical femoral fracture (AFF), a rare orthopedic complication typically associated with prolonged bisphosphonate use.
Results: Despite normal laboratory bone markers, she experienced debilitating pain culminating in an urgent care visit, where radiographs revealed an incomplete transverse subtrochanteric femur fracture. Previous skeletal issues, including avascular necrosis, atraumatic pars defects and pathologic metatarsal fractures, further complicated her clinical picture. Prophylactic fixation with intramedullary nailing was performed promptly, leading to successful outcomes at follow-up.
Conclusion: The occurrence of atypical femoral fractures linked to chronic Imatinib therapy transcends age, affecting even young patients. Vigilance towards patient symptoms, coupled with awareness of classic radiographic findings, empowers multidisciplinary teams to swiftly identify and manage these complex fractures. Such proactive approaches are paramount in ensuring optimal patient outcomes and mitigating the impact of these challenging fractures, especially in patients with chronic myelogenous leukemia, where Imatinib therapy cannot be discontinued.
