scholarly journals Atypical periprosthetic femoral fractures of the hip: characterisation of three cases

2020 ◽  
Vol 30 (2_suppl) ◽  
pp. 77-85
Author(s):  
Giuseppe Toro ◽  
Ciro Di Fino ◽  
Annalisa De Cicco ◽  
Gabriella Toro ◽  
Marco Paoletta ◽  
...  
Keyword(s):  
Fracture Healing ◽  
Management Strategies ◽  
Femoral Fractures ◽  
Mineral Research ◽  
Periprosthetic Femoral Fractures ◽  
Hip Function ◽  
Lateral Plating ◽  
Oxford Hip Score ◽  
American Society ◽  
Definition Of

Introduction: Long-term use of bisphosphonates (BPs) has been associated with a specific type of tensile side femoral stress fracture known as Atypical Femoral Fracture (AFF). Theoretically periprosthetic femoral fractures (PFF) should be excluded from the diagnosis of AFF. However, emerging evidence correlates prolonged BPs use with the occurrence of a type of PFF with an atypical pattern (atypical PFF, APFF). The aim of the present study is to report 3 cases of APFF treated at a single centre. Methods: Clinical and radiographic records of PFF that occurred between January 2016 and August 2018 were retrospectively reviewed. All patients meeting the American Society for Bone and Mineral Research (ASBMR) criteria for definition of PFF were included. Management strategies for APFF and patient outcomes, including fracture healing and hip function (assessed by the Oxford Hip Score [OHS]) were collected. Results: 3 patients in the study period were identified as APFF (1 incomplete, 2 complete). All patients were females with a mean age of 83.3 years. All patients were treated with lateral plating. The application of a contralateral strut allograft resulted in fracture healing in cases of complete fractures. Mean OHS at final follow-up was 34.3. Conclusions: Despite occurring around a hip stem like PFF, APFF had peculiar clinical and radiographic features, making them more similar to AFF. Therefore, the orthopaedic surgeon should also consider the natural history and healing problems associated with AFF prior in order to choose the most appropriate management for APFF.

scholarly journals Atypical periprosthetic femoral fracture associated with long-term bisphosphonate therapy

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Dávid Dózsai ◽  
Tamás Ecseri ◽  
István Csonka ◽  
István Gárgyán ◽  
Péter Doró ◽  
...  
Keyword(s):  
Femoral Fracture ◽  
Case Reports ◽  
Femoral Stem ◽  
Femoral Fractures ◽  
Atypical Femoral Fracture ◽  
Periprosthetic Fractures ◽  
Periprosthetic Femoral Fracture ◽  
Mineral Research ◽  
Periprosthetic Femoral Fractures

Abstract Background Atypical femoral fracture is one of the many complications after the long-term use of bisphosphonates. The American Society for Bone and Mineral Research has officially excluded periprosthetic femoral fractures (PFFs) from the definition of atypical femoral fractures (AFFs). Several case reports found that PFFs can occur with characteristics similar to those of AFFs. The purpose of our study was to evaluate the proportion of atypical fractures among Vancouver type B1 fractures, and to determine the association between the long-term use of bisphosphonates and the occurrence of atypical periprosthetic femoral fractures (APFFs). Methods In this retrospective study, we reviewed 41 patients with Vancouver type B1 periprosthetic fractures between January 1, 2011 and December 31, 2018. We classified them into two groups, namely atypical and typical PFFs, based on the fracture morphology. We noted the proportion of atypical periprosthetic fractures among B1 fractures and identified risk factors. Results Among the 41 PFFs, 5 (13%) fractures were classified as atypical PFF based on the radiological characteristics. The longer duration of bisphosphonate use was probably the only independent risk factor that significantly increases the occurrence of APFF (p = 0.03, 0.08 (CI 0.008 – 0.16)). There were no significant differences in age, gender, body mass index, comorbidities, corticosteroid use, positioning of the femoral stem, the method of fixation (cemented or cementless) and time lapse from before the primary prosthesis implantation to the PFF in the development of atypical fracture type. Conclusions There seems to be a correlation between the long-term intake of bisphosphonates and the atypical periprosthetic fracture. Atypical femoral fracture can also occur in the periprosthetic form. Trial registration Study number: 22/2019-SZTE, http://www.klinikaikutatas.hu/hu/kutatasetika/jovahagyott-vizsgalatok-koezerdeku-adatai/category/25-jovahagyott-vizsgalatok-kozerdeku-adatai-rkeb-2019.html?download=985:22-2019.

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

2010 ◽  
Vol 25 (11) ◽  
pp. 2267-2294 ◽  
Author(s):  
Elizabeth Shane ◽  
David Burr ◽  
Peter R Ebeling ◽  
Bo Abrahamsen ◽  
Robert A Adler ◽  
...  
Keyword(s):  
Task Force ◽  
Femoral Fractures ◽  
Mineral Research ◽  
American Society

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the American Society for Bone and Mineral Research

2011 ◽  
Vol 26 (8) ◽  
pp. 1987-1987 ◽  
Author(s):  
Elizabeth Shane ◽  
David Burr ◽  
Peter R Ebeling ◽  
Bo Abrahamsen ◽  
Robert A Adler ◽  
...  
Keyword(s):  
Task Force ◽  
Femoral Fractures ◽  
Mineral Research ◽  
American Society

scholarly journals Atypical Subtrochanteric and Diaphyseal Femoral Fractures: Second Report of a Task Force of the American Society for Bone and Mineral Research

2013 ◽  
Vol 29 (1) ◽  
pp. 1-23 ◽  
Author(s):  
Elizabeth Shane ◽  
David Burr ◽  
Bo Abrahamsen ◽  
Robert A Adler ◽  
Thomas D Brown ◽  
...  
Keyword(s):  
Task Force ◽  
Femoral Fractures ◽  
Mineral Research ◽  
American Society

Atypical Femoral Fracture in a Patient without Bisphosphonate or Denosumab Exposure-A Case Report

2021 ◽  
Vol 11 (10) ◽  
Author(s):  
George F. Georgiadis ◽  
Dimitrios G. Begkas ◽  
Konstantinos A. Maniatis ◽  
Alexandros E. Vasilakis ◽  
Stamatios Theodoros D. Chatzopoulos ◽  
...  
Keyword(s):  
Vitamin D ◽  
Femoral Fractures ◽  
Subsequent Treatment ◽  
Periosteal Reaction ◽  
Mineral Research ◽  
Osteoporosis Therapy ◽  
Atypical Femoral Fractures ◽  
Femoral Cortex ◽  
Antiresorptive Drugs ◽  
American Society

Introduction: Atypical femoral fractures (AFF) are associated with the use of bisphosphonates (BPs) or denosumab. However, few cases that meet the characteristics of these fractures, as established by the American Society of Bone and Mineral Research, have occurred in patients who have never used antiresorptive drugs. Case Report:We report a case of AFF in a 67-year-old woman who had never used antiresorptive medications. The history and comorbidities of the patient, the characteristics of the fracture, and the subsequent treatment are presented. Conclusion: AFFs may occur even in patients who have never been exposed to BPs or denosumab. The absence of antiresorptive osteoporosis therapy and the lack of radiographic focal periosteal reaction in the lateral femoral cortex, as in our case, can make it difficult to detect and prevent the disorder. Prolonged use of proton pump inhibitors and Vitamin D deficiency-related osteomalacia may contribute to the occurrence of these fractures. Further studies are required to accurately understand all inciting factors contributing to the development of AFFs. Keywords: Atypical femoral fractures, subtrochanteric fractures, denosumab, bisphosphonates, antiresorptive drugs.

scholarly journals Periprosthetic Femoral Fractures in Total Hip Arthroplasty (THA): Comparison Between Osteosynthesis and Revision

2021 ◽  
Author(s):  
Gianluca Scalici ◽  
Debora Boncinelli ◽  
Luigi Zanna ◽  
Roberto Buzzi ◽  
Laura Antonucci ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Total Hip Arthroplasty ◽  
Internal Fixation ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Femoral Fractures ◽  
Total Hip ◽  
Periprosthetic Femoral Fractures ◽  
Oxford Hip Score ◽  
Type Of Fracture

Abstract Background Periprosthetic fractures are challenging complication of hip arthroplasty and a rare injury, but their incidence is increasing. The surgical treatment is demanding to achieve early mobilization and avoid the complications of prolonged recumbency. The aim of this study is to evaluate the clinical outcomes of surgical treatment in periprosthetic femoral fractures of hip arthroplasty, making a comparison between implant revision and reduction and internal fixation of the fracture.Methods Authors retrospectively reviewed a series of 117 patients with total hip arthroplasty treated for periprosthetic femur fractures in the period between January 2013 and March 2018 at a single tertiary referral center. We collected the data of 70 patients who satisfied inclusion criteria. The fractures were classified according to the Unified Classification System (UCS) and randomized in two groups: reduction and internal fixation (G1) or revision arthroplasty (G2). Clinical outcomes were assessed with Oxford Hip Score post and pre-surgery, Barthel Score in relation to CIRS score (Cumulative illness rating scale), the type of fracture and post-operative complications with a minimum follow up of one year.Results Nominal univariable statistical analysis revealed significantly results concerning the difference between the post and pre-operative Oxford Hip Score (D Oxford) with type of treatment (p=0,008) and with the CIRS score (p=0,048). Moreover, we observed a strong significant relationship between type of treatment and type of fracture (P=0,0001). Multivariable analyses revealed that CIRS score was independently associated with Oxford Score improvement after surgery (P=0,024).Conclusions Authors reported how the surgical revision has a better functional outcome in B2 type of fracture than B1 or C, but the chosen treatment should be related to surgeon’s experience and patient’s comorbidities and a multidisciplinary team.

Outcomes of Vancouver B2 and B3 periprosthetic femoral fractures after total hip arthroplasty in elderly patients

2018 ◽  
Vol 29 (2) ◽  
pp. 184-190 ◽  
Author(s):  
Jesús Moreta ◽  
Iker Uriarte ◽  
Amaia Ormaza ◽  
Javier Mosquera ◽  
Kattalin Iza ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Fracture Healing ◽  
Femoral Fractures ◽  
Functional Results ◽  
High Rate ◽  
Periprosthetic Fractures ◽  
Harris Hip Score ◽  
Periprosthetic Femoral Fractures ◽  
The Mean

Introduction: The objective was to evaluate clinical and radiological outcomes of Vancouver B2 and B3 periprosthetic femoral fractures in patients older than 65 years treated at our institution from 2000 to 2014. We compared the most common methods of fixation: a modular tapered rectangular titanium stem versus a monoblock tapered stem. Methods: A retrospective review was performed with a minimum follow-up time of 2 years. Patient mobility in the period prior to the fracture and after fracture healing and functional results was assessed according to the Harris Hip Score. Results: A total of 43 Vancouver B2 and B3 periprosthetic fractures fulfilled the inclusion criteria (31 type B2 and 13 type B3). The mean age was 78 years old (66–88 years). The mean follow-up time was 5 years (range 2–12 years). A Wagner stem was used in 19 patients and a modular rectangular stem was implanted in 24 patients. Although fracture union was achieved in 93% of the cases, the mean Harris Hip Score was 73 (34–87) and 41.9% of the patients did not return to their previous ambulatory levels ( p = 0.0049). Dislocation was the most common complication (16.3%). We have found association ( p = 0.07) between subsidence with a mean of 4.14 mm and dislocation. No difference was observed between B2 and B3 fractures or between modular and monoblock stems. Discussion: Although we reported good results of fracture healing, there were functional impairment and a high rate of complications, especially dislocation, in Vancouver B2 and B3 periprosthetic fractures in elderly patients.

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