REVISTA MEDICINA LEGAL DE COSTA RICA Vol. 37 (2) Septiembre 2020
REVISTA MEDICINA LEGAL DE COSTA RICA
ISSN 2215-5287
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Fracturas atípicas de fémur asociadas al uso de bifosfonatos
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Bisphosphonate associated atypical femur fractures
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Médica Residente de Medicina Legal, Universidad de Costa Rica, Departamento de Medicina Legal, Poder Judicial.
Heredia, Costa Rica.
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Resumen
C'2!;)D'2D'*%A'2!2'*!E.4),%E.*A'2!%E3()%E.*A.!,'*',)4'2!3'&!21!.D.,A'!%*A%0'*)2A%!4.!(%!&.2'&,)F*!F2.%!
G!(%!,'*2.,1.*A.!&.41,,)F*!4.(!&).20'!4.!D&%,A1&%2!.*!('2!3%,).*A.2!,'*!'2A.'3'&'2)29!C%!()A.&%A1&%!%,A1%(!
3&'H..!.H)4.*,)%!.*!AI&E)*'2!4.!4%A'2!,(J*),'2!G!.K3.&)E.*A%(.2!L1.!%2',)%*!.(!12'!3&'('*0%4'!4.!.2A'2!
E.4),%E.*A'2!,'*!1*!%1E.*A'!.*!.(!&).20'!4.!D&%,A1&%2!%AJ3),%2!4.!DIE1&9!!
+%&%!.2A%;(.,.&!2)!.2A%!%2',)%,)F*!.2!,(J*),%E.*A.!&.(.H%*A.M!2.!&.L1).&.!&.%()N%&!.2A14)'2!3'2A.&)'&.2!L1.!
)*,(1G%*!(%!&.(%,)F*!.*A&.!'A&'2!D%,A'&.2!L1.!3'4&J%*!)*D(1)&!.*!(%!%3%&),)F*!4.!.2A.!A)3'!4.!D&%,A1&%2!,'E'!('!
.2!(%!3&'3)%!.*D.&E.4%4!'2A.'3'&FA),%M!.(!A)3'!4.!;)D'2D'*%A'!1A)()N%4'M!.(!E.,%*)2E'!(.2)'*%(!L1.!'&)0)*F!
(%!D&%,A1&%M!E.4),%E.*A'2!,'*,'E)A%*A.2!G!3%A'('0J%2!%2',)%4%29!
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Palabras claves
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Fuente: DeCS (Descriptores en Ciencias de la Salud)
Abstract
O)23-'23-'*%A.2!%&.!E.4),%A)'*2!A-%A!%&.!P)4.(G!Q*'P*!D'&!A-.)&!%*A%0'*)N)*0!.DD.,A!'*!;'*.!&.2'&3A)'*!
%*4! A-.)&! ,'*2.L1.*A! &.41,A)'*! )*! A-.! &)2Q! 'D! D&%,A1&.2! )*! 3%A).*A2! P)A-! '2A.'3'&'2)29! $1&&.*A! ()A.&%A1&.!
3&'H)4.2!.H)4.*,.!)*!A.&E2!'D!.K3.&)E.*A%(!%*4!,()*),%(!4%A%!%22',)%A)*0!3&'('*0.4!12.!'D!A-.2.!4&102!P)A-!
%*!)*,&.%2.!)*!A-.!&)2Q!'D!%AG3),%(!D.E1&!D&%,A1&.29!
REVISTA MEDICINA LEGAL DE COSTA RICA Vol. 37 (2) Septiembre 2020
REVISTA MEDICINA LEGAL DE COSTA RICA
ISSN 2215-5287
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R'!.2A%;()2-!)D!A-)2!%22',)%A)'*!)2!,()*),%((G!&.(.H%*AM!A-.&.!().2!%!*..4!D'&!D1&A-.&!2A14).2!A-%A!A%Q.!)*A'!%,,'1*A!
'A-.&!D%,A'&2!A-%A!E)0-A!)*D(1.*,.!A-.!',,1&&.*,.!'D!A-.2.!AG3.!'D!D&%,A1&.2M!()Q.!A-.!'2A.'3'&'A),!4)2.%2.!
)A2.(DM!%0.M!)*A%Q.!'D!'A-.&!4&102!%*4!%22',)%A.4!2G2A.E),!)((*.22.29!
Key words
Sudden death, ectopic pregnancy, broken ectopic pregnancy, hemoperitoneum, legal medicine.
Source: DeCS (Descriptors in Health Sciences)
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Introducción
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C'2! ;)D'2D'*%A'2! 2'*! 1*! 0&13'! 4.! E.4),%E.*A'2! 1A)()N%4'2! ,'*! D&.,1.*,)%! 3%&%! A&%A%&! (%! '2A.'3'&'2)29!
@1E.*A%*!(%!E)*.&%()N%,)F*!4.(!-1.2'!%(!4)2E)*1)&!(%!&.2'&,)F*9!C%!&.41,,)F*!4.(!&).20'!4.!D&%,A1&%2!4.!
,'(1E*%!G!,%4.&%!.2!,'*2)4.&%;(.!G!;).*!&.,'*',)4'!3'&!(%!.H)4.*,)%!,(J*),%9!
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,'*2)4.&%4%2!%AJ3),%2!.*!.(!DIE1&9
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Metodología
C%!&.H)2)F*!4.!(%!()A.&%A1&%!D1.!((.H%4%!%!,%;'!1A)()N%*4'!(%2!;%2.2!4.!4%A'2!.(.,A&F*),%2!;)'EI4),%2!S''0(.!
T,-'(%&M! S''0(.! G! +1;U.49! C%2! 3%(%;&%2! ,(%H.! 1A)()N%4%2! 3%&%! ;12,%&! .*! (%2! ;%2.2! 4.! 4%A'2! D1.&'*5!
;)D'2D'*%A'2M!D&%,A1&%!%AJ3),%!4.!DIE1&M!&.2'&,)F*!F2.%M!G!'2A.'3'&'2)29!V'!2.!1A)()NF!*)*0W*!2'DAP%&.!3%&%!
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Resultado del estudio
C'2!;)D'2D'*%A'2! ,'E'!DX&E%,'2! %*A)'2A.'3'&FA),'2!-%*!&.21(A%4'!2.&!E1G!.D.,A)H'2!.*!(%!&.41,,)F*!4.!
D&%,A1&%2!4.!H.&A.;&%(.2!3&)*,)3%(E.*A.9!+'&!.2A%!&%NF*M!2.!1A)()N%*!,'E'!A&%A%E).*A'!4.!3&)E.&%!(J*.%!,'*A&%!
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R62,'&.!)*D.&)'&!%!6<9[!.(!,&)A.&)'!3&)*,)3%(!2.0W*!(%!\&0%*)N%,)F*!U1*4)%(!4.!(%!T%(14!Y<Z9!]2A.!;.*.D),)'!
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REVISTA MEDICINA LEGAL DE COSTA RICA Vol. 37 (2) Septiembre 2020
REVISTA MEDICINA LEGAL DE COSTA RICA
ISSN 2215-5287
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DIE1&!,'E'!%AJ3),%M!.2A%!4.;.!.2A%&!(',%()N%4%!%!('!(%&0'!4.!(%!4)XD)2)2!D.E'&%(M!L1.!H%!4.24.!(%!3'&,)F*!4)2A%(!
4.(!A&',X*A.&!E.*'&M!-%2A%!(%!3'&,)F*!3&'K)E%(!4.!(%!3&'E)*.*,)%!213&%,'*4J(.%9!@4.EX2M!4.;.*!4.!.2A%&!
3&.2.*A.2! ,1%A&'! 4.! (%2! ,)*,'! ,%&%,A.&J2A),%2! E%G'&.2M! E.*,)'*%4%2! .*! (%! A%;(%! ?! Y"Z9! ]K)2A.*! A%E;)I*!
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Características mayores
1. C%!D&%,A1&%!2.!%2',)%!%!1*!A&%1E%!EJ*)E'M!,'E'!1*%!,%J4%!4.24.!(%!3&'3)%!%(A1&%!'!2)*!
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2. C%!(J*.%!4.!D&%,A1&%!2.!'&)0)*%!.*!(%!,'&A.N%!(%A.&%(!G!.2!A&%*2H.&2%(!.*!21!'&).*A%,)F*M!
31.4.!,'*H.&A)&2.!.*!';(),1%!2.0W*!3&'0&.2.!%!A&%HI2!4.(!DIE1&9
3. C%2! D&%,A1&%2! ,'E3(.A%2! 2.! .KA).*4.*! %! A&%HI2! 4.! %E;%2! ,'&A),%(.29! C%2! D&%,A1&%2!
)*,'E3(.A%2!%D.,A%*!2F('!(%!,'&A.N%!(%A.&%(9
4. C%!D&%,A1&%!*'!.2!,'*E)*1A%!'!EJ*)E%E.*A.!,'*E)*1A%9
5. d%G!.*0&'2%E).*A'!(',%()N%4'!4.(!3.&)'2A)'!'!.(!.*4'2A)'!.*!.(!(10%&!4.!(%!D&%,A1&%9
Tabla 1. Características mayores de fractura atípica de fémur.
Características menores
1. @1E.*A'!0.*.&%()N%4'!.*!.(!0&'2'&!,'&A),%(!4.!(%!4)XD)2)2!D.E'&%(9
2. e'('&!1*)!'!;)(%A.&%(!.*!(%!)*0(.!'!.*!.(!E12('!,'E'!2J*A'E%!3&'4&FE),'9
3. /&%,A1&%!4.!4)XD)2)2!,'E3(.A%!'!;)(%A.&%(!)*,'E3(.A%9
4. :.A%&4'!.*!(%!,'*2'()4%,)F*!4.!(%!D&%,A1&%9
Tabla 2. Características menores de fractura atípica de fémur.
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213&.2)F*!4.(!&.E'4.(%4'!F2.'9!]2A.!-1.2'!2)*!&.E'4.(%,)F*M!4.3'2)A%4'!%!('!(%&0'!4.(!12'!.KA.*2'!4.!('2!
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4.(!-1.2'!*'&E%(M!H'(H)I*4'2.!EX2!D&X0)(!Y#Z9!!
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REVISTA MEDICINA LEGAL DE COSTA RICA Vol. 37 (2) Septiembre 2020
REVISTA MEDICINA LEGAL DE COSTA RICA
ISSN 2215-5287
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REVISTA MEDICINA LEGAL DE COSTA RICA Vol. 37 (2) Septiembre 2020
REVISTA MEDICINA LEGAL DE COSTA RICA
ISSN 2215-5287
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Referencias
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-AA35ffPPP9.E%9.1&'3%9.1f.E%f)*4.K9823h,1&(i3%0.2fE.4),)*.2f-1E%*f31;(),!
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<9 S.4E)*A%2!CM!T'('E'*!edM!m)E!T$9!O)23-'23-'*%A.2!%*4!&)2Q!'D!21;A&',-%*A.&),M!D.E'&%(!2-%DAM!
%*4!%AG3),%(!D.E1&!D&%,A1&.5!%!2G2A.E%A),!&.H).P!%*4!E.A%6%*%(G2)29!J Bone Miner Res
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REVISTA MEDICINA LEGAL DE COSTA RICA Vol. 37 (2) Septiembre 2020
REVISTA MEDICINA LEGAL DE COSTA RICA
ISSN 2215-5287
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