scholarly journals Clinical Features and Outcomes of Bilateral Atypical Femoral Fractures

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Kosuke Hamahashi ◽  
Toshihiro Noguchi ◽  
Yoshiyasu Uchiyama ◽  
Masato Sato ◽  
Masahiko Watanabe
Keyword(s):  
Clinical Features ◽  
Lupus Erythematosus ◽  
Femoral Fractures ◽  
Fracture Site ◽  
Prophylactic Surgery ◽  
Atypical Femoral Fractures ◽  
Lateral Cortex ◽  
Previously Treated ◽  
The Mean ◽  
Complete Fracture

Bilateral atypical femoral fractures (AFFs) are relatively rare. In this report, we retrospectively researched clinical features and outcomes of bilateral AFFs treated at our institution. We previously treated 4 patients (8 limbs) with intramedullary nailing for complete AFFs (6 limbs) and incomplete AFFs (2 limbs). The mean age at the first operation was 53.3 years, and all patients were female. Of the 4 patients, two had breast cancer, and another two had systemic lupus erythematosus. Three of them received bisphosphonates, and 2 received denosumab, proton pump inhibitor, or glucocorticoid therapy. Only 2 of 6 cases of incomplete AFFs had prodromal pain before progressing to complete fracture. The mean interval from the first surgery to contralateral fracture or prophylactic surgery was 16 months. Radiographically, complete bone union was achieved in 6 limbs. However, a small gap at the lateral cortex of fracture site remained in 2 limbs. Finally, all of the patients were pain-free and able to walk without a cane. It is absolutely necessary to confirm contralateral femoral conditions; however, prediction of progression to complete fracture based solely on prodromal pain was difficult. Therefore, we should advise patients about the danger of progression to complete AFFs even if they are asymptomatic, and a prophylactic surgery should be performed after obtaining informed consent.

Mid-term outcomes after the surgical treatment of atypical femoral fractures

2021 ◽  
Vol 103-B (11) ◽  
pp. 1648-1655
Author(s):  
Soo-Young Jeong ◽  
Kyu-Tae Hwang ◽  
Chang-Wug Oh ◽  
Joon-Woo Kim ◽  
Oog Jin Sohn ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Femoral Fractures ◽  
Delayed Union ◽  
Fracture Site ◽  
High Grade ◽  
Atypical Femoral Fractures ◽  
Factors Affecting ◽  
The Mean

Aims The incidence of atypical femoral fractures (AFFs) continues to increase. However, there are currently few long-term studies on the complications of AFFs and factors affecting them. Therefore, we attempted to investigate the outcomes, complications, and risk factors for complication through mid-term follow-up of more than three years. Methods From January 2003 to January 2016, 305 patients who underwent surgery for AFFs at six hospitals were enrolled. After exclusion, a total of 147 patients were included with a mean age of 71.6 years (48 to 89) and 146 of whom were female. We retrospectively evaluated medical records, and reviewed radiographs to investigate the fracture site, femur bowing angle, presence of delayed union or nonunion, contralateral AFFs, and peri-implant fracture. A statistical analysis was performed to identify the significance of associated factors. Results The mean follow-up period was 70.2 months (36 to 191). There were 146 AFFs (99.3%) in female patients and the mean age was 71.6 years (48 to 89). The AFFs were located in the subtrochanter and shaft in 52 cases (35.4%) and 95 (64.6%), respectively. The preoperative mean anterior/lateral femoral bowing angles were 10.5° (SD 5.7°)/6.1° (SD 6.2°). The postoperative mean anterior/lateral bowing values were changed by 8.7° (SD 5.4°)/4.6° (SD 5.9°). Bisphosphonates had been used contemporarily in 115 AFFs (78.2%) for a mean of 52.4 months (1 to 204; SD 45.5) preoperatively. Nailing was performed in 133 AFFs (90.5%), and union was obtained at a mean of 23.6 weeks (7 to 85). Delayed union occurred in 41 (27.9%), and nonunion occurred in 13 (8.8%). Contralateral AFF occurred in 79 patients (53.7%), and the use of a bisphosphonate significantly influenced the occurrence of contralateral AFFs (p = 0.019). Peri-implant fractures occurred in a total of 13 patients (8.8%), and a significant increase was observed in cases with plating (p = 0.021) and high grade of postoperative anterolateral bowing (p = 0.044). Conclusion The use of a bisphosphonate was found to be a risk factor for contralateral AFF, and high-grade postoperative anterolateral bowing and plate fixation significantly increased the occurrence of peri-implant fractures. Long-term follow-up studies on the bilaterality of AFFs and peri-implant fractures are warranted. Cite this article: Bone Joint J 2021;103-B(11):1648–1655.

scholarly journals Scoring System for Identifying Impending Complete Fractures in Incomplete Atypical Femoral Fractures

2016 ◽  
Vol 102 (2) ◽  
pp. 545-550 ◽  
Author(s):  
Byung-Woo Min ◽  
Kyung-Hoi Koo ◽  
Youn-Soo Park ◽  
Chang-Wug Oh ◽  
Seung-Jae Lim ◽  
...  
Keyword(s):  
Roc Curve ◽  
Scoring System ◽  
Interobserver Reliability ◽  
Radiolucent Line ◽  
Intraclass Correlation ◽  
Reliability And Validity ◽  
Femoral Fractures ◽  
Atypical Femoral Fractures ◽  
Pain Status ◽  
Complete Fracture

Abstract Context: Although impending incomplete atypical femoral fractures (AFFs) require prophylactic fixation, there is still a lack of study on predicting complete fracture among the incomplete AFFs. Objective: Our purposes are to develop a scoring system to predict progression into complete fracture and to evaluate its reliability and validity. Design, Setting, and Patients: We reviewed 46 incomplete AFFs in 44 patients who did not undergo prophylactic fixation. A weighted scoring system, including four identified risk factors (the site, severity of pain, status of the contralateral femur, and the extent of radiolucent line), was developed. We evaluated its interobserver reliability by using intraclass correlation coefficiency (ICC) and its accuracy using receiver operator characteristic (ROC) curve. The validity of the scoring system was tested in a different cohort. Intervention: Observational study. Main Outcome Measure: Progression to complete fracture within 6 months. Results: Among 46 incomplete fractures, 13 developed a complete fracture within 6 months. The probability of complete fracture increased abruptly when the score was 8 points or more. The proposed scoring system showed an almost perfect reliability (ICC, 0.997; 95% confidence interval, 0.995 to 0.998) and higher accuracy than any single risk factor in ROC curve. In the different series, the positive predictive value was 100% and the sensitivity was 75%, when cutoff value was 8 points. Conclusion: The progression to complete fracture could be predicted by using our scoring system. Incomplete AFF with scores <8 points can be treated conservatively, whereas lesions with scores ≥8 require prophylactic fixation.

scholarly journals Fractures in Corticosteroid- and Bisphosphonate-treated Subjects With Longstanding Rheumatoid Arthritis

2021 ◽  
Author(s):  
Atie Moghtadaie ◽  
Seyed Amir Miratashi Yazd ◽  
Ahmad Salimzadeh
Keyword(s):  
Rheumatoid Arthritis ◽  
Lupus Erythematosus ◽  
Femoral Fractures ◽  
Bone Diseases ◽  
Multiple Fractures ◽  
Metabolic Bone Diseases ◽  
Atypical Femoral Fractures ◽  
Therapy Assessment ◽  
History Of

Background: Bisphosphonates are the most widely prescribed agents for the treatment of postmenopausal osteoporosis and other metabolic bone diseases. Atypical femoral fractures in bisphosphonate-treated patients have raised concerns regarding the long-term safety of this class of medications. Case Presentation: In this study, we report two patients suffering from fractures while receiving biphosphonates; a postmenopausal patient with rheumatoid arthritis and a history of long-term use of bisphosphonates and glucocorticoids presenting with multiple fractures as case one and another 52-year-old female patient diagnosed with Systemic Lupus Erythematosus (SLE) who suffered from a femoral shaft fracture without any history of prior traumatic incidents as case two. Conclusions: Considering the low risk for atypical femoral fractures, further careful screening for these types of fractures should be undertaken. In addition, in order to lower the rate of fractures in patients on long-term bisphosphonate therapy, assessment of patients’ contralateral side should be considered to prevent further fractures, especially in patients with prodromal pain.

scholarly journals Incomplete atypical femoral fractures after bisphosphonate use in postmenopausal women

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987526
Author(s):  
Umut Canbek ◽  
Ulas Akgun ◽  
Deniz Soylemez ◽  
Tugba Dubektas Canbek ◽  
Nevres Hurriyet Aydogan
Keyword(s):  
Parathyroid Hormone ◽  
Postmenopausal Women ◽  
Hospital Costs ◽  
Femoral Fractures ◽  
Mineral Density ◽  
Atypical Femoral Fractures ◽  
Potential Risk Factors ◽  
25 Hydroxy Vitamin D ◽  
The Mean ◽  
Bone Scans

Purpose: This study aimed to determine the prevalence of incomplete atypical femoral fractures (iAFFs) in postmenopausal women using bisphosphonates and to investigate the potential risk factors for the development of iAFF. Methods: The national health-care records system indicated that 2746 postmenopausal women in our region aged ≥50 years were taking bisphosphonates. Using an assumed iAFF prevalence of 10% and levels of 5% α significance and ±5% precision, we calculated that a sample size of 132 participants was needed for this study. The patients were randomly selected and invited to the hospital. Radiographs and bone scans were used to evaluate each patient for iAFF. Bone mineral density, 25-hydroxy vitamin D, parathyroid hormone, and alkaline phosphatase measurements were performed. Results: The mean age of the study population was 72.79 ± 7.35 years, and the mean duration of bisphosphonate use was 7.7 ± 3.4 years. We found iAFF in 14 (10.6%) patients, and 3 patients had bilateral involvement. Of the 17 femurs with iAFF, a proximal third location was seen in 2 patients (11.8%), a mid-third location in 14 (82.4%), and a distal third location in 1 (5.9%). The duration of bisphosphonate use was longer, and parathyroid hormone levels were higher in patients with iAFF compared to those without an incomplete fracture. Conclusion: We found a relatively higher prevalence of iAFF in postmenopausal women using bisphosphonate. Early identification and treatment of iAFF is crucial for reducing potential patient morbidity and hospital costs.

scholarly journals Atypical Femoral Fractures: Transverse Morphology at Lateral Cortex Is a Critical Feature

2014 ◽  
Vol 29 (3) ◽  
pp. 639-643 ◽  
Author(s):  
Alvin C Ng ◽  
Meng Ai Png ◽  
P Chandra Mohan ◽  
Joyce SB Koh ◽  
Tet Sen Howe
Keyword(s):  
Femoral Fractures ◽  
Critical Feature ◽  
Atypical Femoral Fractures ◽  
Lateral Cortex

scholarly journals Case Report: Prophylactic Plate Fixation for Incomplete Atypical Ulnar Fractures Resulting From the Use of Denosumab for Bone Metastases

2022 ◽  
Vol 12 ◽  
Author(s):  
Atsuro Murai ◽  
Kaoru Tada ◽  
Tadahiro Nakajima ◽  
Mika Akahane ◽  
Masashi Matsuta ◽  
...  
Keyword(s):  
Bone Resorption ◽  
Bone Metastases ◽  
Plate Fixation ◽  
Femoral Fractures ◽  
Prophylactic Surgery ◽  
Atypical Femoral Fractures ◽  
Metastatic Lesions ◽  
Ulna Fractures ◽  
Inhibitor Treatment

Patients with bone metastases are treated with long-term bone resorption inhibitors such as bisphosphonates and denosumab. However, resorption inhibitors have been known to cause fractures, such as atypical femoral fractures (AFFs). In recent years, there have been an increasing number of reports of atypical ulna fractures (AUFs) caused by bone resorption inhibitor usage. Treatment of AUFs is complicated, especially when they occur in patients with bone metastases, because it is difficult to discontinue bone resorption inhibitor treatment without the risk of aggravating metastatic lesions. Prophylactic surgery is recommended in AFFs when fractures are predicted, but there are few reports of prophylactic surgery for AUFs. Here, we report a case of incomplete AUF in a 74-year-old woman which was surgically treated with prophylactic plate fixation. The patient had been using denosumab for 6 years to treat bone metastases due to thyroid cancer. After surgery, no fractures were observed for 2 years without discontinuing denosumab, and her forearm function was adequate. AUFs are rare and difficult to treat, so oncologists who treat bone metastases need to pay special attention to diagnose this incomplete AUF before the fracture worsens. We believe that detection of a possible fracture and prophylactic surgery can improve prognosis.

scholarly journals Unique Characteristics of Prepubertal Onset Systemic Lupus Erythematosus

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
R. Abdwani ◽  
E. Abdalla ◽  
I. Al-Zakwani
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Clinical Features ◽  
Lupus Erythematosus ◽  
Statistical Tests ◽  
Disease Onset ◽  
Age At Diagnosis ◽  
Systemic Lupus ◽  
Cutaneous Manifestations ◽  
Pubertal Onset ◽  
The Mean

Objectives. The aim of this study was to investigate the influence of age at disease onset on disease expression and outcomes of pediatric systemic lupus erythematosus SLE (pSLE). Methods. A total of 103 patients with pSLE from Sultan Qaboos University Hospital, Oman, were retrospectively studied. Epidemiological, clinical phenotype, disease severity, serology, treatment, and outcome were compared among the three groups using univariate statistical tests. Results. The mean disease duration of the cohort was 9.8 ± 4.7 years. The patients were divided into three groups: prepubertal onset (n=39) with mean age at diagnosis of 5.1 ± 2.0 years and pubertal disease onset (n=29) with mean age at diagnosis of 10.8 ± 1.0 years as well as postpubertal disease onset (n=35) group with mean age at diagnosis of 15.3 ± 1.6 years. The prepubertal pSLE cohort demonstrates unique characteristics with increased frequency of familial SLE (61%) of which 49% were from first-degree relatives. Similarly, this group had distinctive clinical features, which included increased renal disease in pubertal and postpubertal groups, respectively (51% vs 23% vs 20%; p=0.039). Prepubertal, similar to pubertal group, had a higher incidence of cutaneous manifestations than in the postpubertal group (74% vs 69% vs 46%; p=0.029). Laboratory features in prepubertal group were distinct with increased frequency of positive anti-cardiolipin antibodies (47%), anti-glycoprotein antibodies (42%), ANCA (62%), and low complement levels (97%) compared to pubertal and postpubertal group. The prepubertal group also has the lowest frequency of positive SSA antibodies (18%) and SSB antibodies (5.1%). The overall mean SLEDAI score in pSLE cohort was 15.6 ± 18.5. The mean SLEDAI scores among the groups showed no significance difference (p=0.110). The overall SLICC DI ≥1 was 36% with a mean damage score of 0.76 ± 1.38. No significant differences in damage index (SLICC DI ≥1) were noted among the groups. Conclusions. Distinct clinical features were identified in prepubertal onset pSLE population of Arab ethnicity. Given the high rate of consanguineous marriage and high frequency of familial SLE in this cohort, these manifestations could be explained by higher frequency of genetic factors that influence the disease pathogenesis.

scholarly journals Prophylactic Nailing of Incomplete Atypical Femoral Fractures

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Chang-Wug Oh ◽  
Jong-Keon Oh ◽  
Ki-Chul Park ◽  
Joon-Woo Kim ◽  
Yong-Cheol Yoon
Keyword(s):  
Femoral Fractures ◽  
Femoral Shaft ◽  
Bisphosphonate Therapy ◽  
Lateral Aspect ◽  
Atypical Femoral Fractures ◽  
Femoral Shaft Fractures ◽  
The Mean ◽  
Minimum Followup ◽  
Im Nailing

Introduction. Recent reports have described the occurrence of low-energy subtrochanteric and femoral shaft fractures associated with long-term bisphosphonate use. Although information regarding the surgical treatment of these atypical femoral fractures is increasing, it is unclear if the preventive operation is useful in incomplete fractures. This study examined the results of preventive intramedullary nailing for incomplete atypical femoral fractures.Material and Methods. A retrospective search was conducted for patients older than 50 years receiving bisphosphonate therapy, with incomplete, nondisplaced fractures in either the subtrochanteric or diaphyseal area of the femur. Seventeen patients with a total of 20 incomplete, non-displaced lesions were included. The mean duration of bisphosphonate use was 50.5 months. Eleven of the 17 (64.7%) patients had complete or incomplete fractures on the contralateral femur. All were treated with prophylactic fixation of an intramedullary (IM) nail. The minimum followup was 12 months.Results. All cases healed with a mean period of 14.3 weeks. Nineteen of the 20 cases healed with the dissolution of incomplete fractures of the lateral aspect. A complete fracture developed at the time of nailing in one patient, but it healed with callus bridging.Conclusion. IM nailing appears to be a reliable way of preventing the progress of incomplete atypical femoral fractures.

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