A Retrospective Review on Atypical Femoral Fracture: Operative Outcomes and the Risk Factors for Failure

Background: Atypical femoral fractures have been demonstrated to have high risks of reoperation and nonunion. The aim of this study is to evaluate whether the quality of reduction following operative fixation of atypical femoral fracture predicts failure. Methods: This is a 6.5-year retrospective review of atypical femoral fractures from 2 centers in a high-income region. A total of 56 patients with 66 fractures met our inclusion criteria. The quality of reduction was evaluated from postoperative films according to Hoskins’ modification of Baumgartner criteria for subtrochanteric fractures. Our primary outcome measure was failure of treatment, defined as either reoperation or nonunion at 12 months. Results: There were a total of 8 reoperations (12% of all fractures) and 8 nonunion (12% of all fractures), affecting a total of 12 fractures (18%) in 12 patients (21%). Closed reduction ( P = .04) and poor quality of reduction ( P = .0227 Fisher exact test) are statistically significant risk factors for failure. Conclusions: An aim for anatomical reduction with both <4 mm maximal cortical displacement and <10° angulation can improve the operative outcome of atypical femoral fractures. The addition of open reduction may be beneficial.

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Venous Thromboembolism and High Grade Gliomas

Thrombosis and Haemostasis ◽

10.1055/s-0038-1649592 ◽

1993 ◽

Vol 70 (03) ◽

pp. 393-396 ◽

Cited By ~ 38

Author(s):

Mandeep S Dhami ◽

Robert D Bona ◽

John A Calogero ◽

Richard M Hellman

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Medical Center ◽

Significant Risk ◽

Bleeding Complications ◽

Fisher Exact Test ◽

High Grade ◽

Chi Square ◽

Exact Test ◽

High Grade Gliomas

SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.

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Evaluation of the nature and etiologies of risk factors for diaphyseal atypical femoral fractures

Medical Principles and Practice ◽

10.1159/000517484 ◽

2021 ◽

Author(s):

Hiroyuki Tsuchie ◽

Naohisa Miyakoshi ◽

Yuji Kasukawa ◽

Koji Nozaka ◽

Kimio Saito ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analyses ◽

Femoral Fractures ◽

Japanese Patients ◽

High Serum ◽

Control Group ◽

Atypical Femoral Fractures ◽

Factors Affecting ◽

Lateral Curvature ◽

Low Serum

Objectives: Differences in the mechanisms of subtrochanteric and diaphyseal atypical femoral fractures (AFFs) have been speculated in studies that have analyzed differences in the patients’ backgrounds. However, the etiologies of each type of AFF have not been investigated in detail. Therefore, this study aimed to investigate the nature and etiologies of the risk factors for diaphyseal AFFs. Materials and Methods: Eighty consecutive Japanese patients with 91 diaphyseal AFFs (the AFF group) and 110 age-matched female patients with osteoporosis (the non-AFF control group) were included. Their clinical data were compared and the factors affecting AFFs were investigated. Furthermore, the etiologies of the risk factors for diaphyseal AFFs were examined. Results: Multivariate analysis revealed that femoral serrated changes, bisphosphonate or denosumab usage, and lateral and anterior femoral curvatures were the risk factors for diaphyseal AFFs (p<0.0011, p=0.0137, and p<0.0001, respectively). Multivariate analyses also revealed that serrated changes and low serum 25(OH)D levels affected the lateral curvature (p=0.0088 and 0.0205, respectively), while serrated changes affected the anterior curvature (p=0.0006); each significantly affected the femoral curvature. In addition, a high serum calcium (Ca) level, lateral femoral curvature, and anterior femoral curvature were the predictors of serrated changes (p=0.0146, 0.0002, and 0.0098, respectively). Conclusion: The risk factors for diaphyseal AFFs were bone resorption inhibitor usage, a strong femoral curvature, and serrated changes. A low serum 25(OH)D level and serrated changes are the risk factors for lateral curvature, while a high serum Ca level is a risk factor for serrated changes.

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Endoprosthetic Reconstruction for a Displaced Atypical Femoral Fracture in a Cancer Patient with Poor Prognosis

Case Reports in Orthopedics ◽

10.1155/2018/7862516 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Hironari Tamiya ◽

Hiroki Hagizawa ◽

Takaaki Nakai ◽

Yoshinori Imura ◽

Takaaki Tanaka ◽

...

Keyword(s):

Cancer Patient ◽

Activities Of Daily Living ◽

Cancer Patients ◽

Femoral Fracture ◽

Daily Living ◽

Poor Prognosis ◽

Femoral Fractures ◽

Endoprosthetic Reconstruction ◽

Atypical Femoral Fractures ◽

Patients With Poor Prognosis

Zoledronate or denosumab treatment is beneficial for cancer patients with bone metastasis. However, each agent may trigger atypical femoral fractures. Incomplete atypical femoral fractures can be successfully treated with prophylactic intramedullary nailing. On the other hand, intramedullary nailing for displaced atypical femoral fractures occasionally causes problems with regard to bone healing, resulting in long-term treatment. In cancer patients with poor prognosis who experience atypical femoral fractures, improvement in activities of daily living should be the priority. Thus, we performed endoprosthetic reconstruction for a displaced atypical femoral fracture in a breast cancer patient with poor prognosis to enable walking in the early stage after the operation. Two weeks after the operation, she could successfully walk. The postoperative Musculoskeletal Tumor Society score was 47%, and it had improved to almost the preoperative level before injury (50%). In conclusion, endoprosthetic reconstruction for displaced atypical femoral fractures may be a first-line treatment approach to acquire early postoperative walking ability for improving activities of daily living in cancer patients with poor prognosis.

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Urinary Incontinence Among Omani Women: Prevalence, risk factors and impact on quality of life

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.2020.20.01.007 ◽

2020 ◽

Vol 20 (1) ◽

pp. 45 ◽

Cited By ~ 1

Author(s):

Maisa H. Al Kiyumi ◽

Zaleikha I. Al Belushi ◽

Sanjay Jaju ◽

Abdulaziz M. Al Mahrezi

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Urinary Incontinence ◽

Primary Healthcare ◽

Short Form ◽

Significant Risk ◽

Medical Attention ◽

Negative Consequences ◽

International Consultation

Objectives: Urinary incontinence (UI) in women is a common health problem which can have a negative impact on quality of life (QOL). This study aimed to determine the prevalence, risk factors and impact of UI on the QOL of Omani women attending primary healthcare centres in Muscat, Oman. Methods: This crosssectional study was conducted at three primary healthcare centres in Muscat from April to August 2018. Women who were 20–50 years of age, not pregnant, not in the six-month postnatal period, not seriously ill and not diagnosed with pelvic organ prolapse were included. A self-administered questionnaire using the International Consultation Incontinence Questionnaire-Short Form was used to evaluate the frequency, severity and impact of UI on QOL. Results: A total of 1,070 women were included in this study (response rate = 92.5%). The mean age was 31.39 ± 7.64 years. UI was reported by 369 (34.5%) women, of whom 182 (49.3%) had stress UI, 97 (26.3%) had urgency UI, 88 (23.8%) had mixed UI and two (0.5%) had other UI. Age, body mass index (BMI), having been married or employed, hypertension, cough, constipation and vaginal or assisted vaginal delivery during the previous birth were significant risk factors for UI. Only 41 (11.1%) out of the 369 women with UI had ever sought medical advice despite the fact that more than two thirds of the women with UI reported negative effects on their QOL. Conclusion: UI is a common medical problem in Oman. Several risk factors, including age and BMI, were identified. Despite its negative consequences for QOL, women were found to be reluctant to seek medical attention for the condition.Keywords: Urinary Incontinence; Prevalence; Risk Factors; Quality of Life; Oman.

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Improving Quality of Surgical Care and Outcomes: Factors Impacting Surgical Site Infection after Colorectal Resection

The American Surgeon ◽

10.1177/000313481408000823 ◽

2014 ◽

Vol 80 (8) ◽

pp. 759-763 ◽

Cited By ~ 5

Author(s):

Virginia Oliva Shaffer ◽

Caitlin D. Baptiste ◽

Yuan Liu ◽

Jahnavi K. Srinivasan ◽

John R. Galloway ◽

...

Keyword(s):

Risk Factors ◽

Glucose Level ◽

Univariate Analysis ◽

Significant Risk ◽

Surgical Care ◽

Surgical Site Infections ◽

Case Volume ◽

Improvement Project ◽

Combining Data

Surgical site infections (SSIs) result in patient morbidity and increased costs. The purpose of this study was to determine reasons underlying SSI to enable interventions addressing identified factors. Combining data from the American College of Surgeons National Surgical Quality Improvement Project with medical record extraction, we evaluated 365 patients who underwent colon resection from January 2009 to December 2012 at a single institution. Of the 365 patients, 84 (23%) developed SSI. On univariate analysis, significant risk factors included disseminated cancer, ileostomy, patient temperature less than 36°C for greater than 60 minutes, and higher glucose level. The median number of cases per surgeon was 36, and a case volume below the median was associated with a higher risk of SSI. On multivariate analysis, significant risks associated with SSI included disseminated cancer (odds ratio [OR], 4.31; P < .001); surgery performed by a surgeon with less than 36 cases (OR, 2.19; P = .008); higher glucose level (OR, 1.06; P 5.017); and transfusion of five units or more of blood (OR, 3.26; P 5.029). In this study we found both modifiable and unmodifiable factors associated with increased SSI. Identifying modifiable risk factors enables targeting specific areas to improve the quality of care and patient outcomes.

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Atypical periprosthetic femoral fracture associated with long-term bisphosphonate therapy

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01941-x ◽

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.

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Retrospective Review of Atypical Femoral Fracture in Metastatic Bone Disease Patients Receiving Denosumab Therapy

The Oncologist ◽

10.1634/theoncologist.2016-0192 ◽

2017 ◽

Vol 22 (4) ◽

pp. 438-444 ◽

Cited By ~ 18

Author(s):

Samantha Peiling Yang ◽

Tae Won B. Kim ◽

Patrick J. Boland ◽

Azeez Farooki

Keyword(s):

Bone Disease ◽

Femoral Fracture ◽

Retrospective Review ◽

Metastatic Bone Disease ◽

Atypical Femoral Fracture

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Risk factors for development of atypical femoral fractures in patients on long-term oral bisphosphonate therapy

Bone ◽

10.1016/j.bone.2013.07.010 ◽

2013 ◽

Vol 56 (2) ◽

pp. 426-431 ◽

Cited By ~ 29

Author(s):

Paola Franceschetti ◽

Marta Bondanelli ◽

Gaetano Caruso ◽

Maria Rosaria Ambrosio ◽

Vincenzo Lorusso ◽

...

Keyword(s):

Risk Factors ◽

Femoral Fractures ◽

Bisphosphonate Therapy ◽

Atypical Femoral Fractures ◽

Oral Bisphosphonate

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Identifying Atypical Femoral Fractures—A Retrospective Review

Calcified Tissue International ◽

10.1007/s00223-014-9908-x ◽

2014 ◽

Vol 95 (5) ◽

pp. 405-412 ◽

Cited By ~ 7

Author(s):

Angela G. Juby ◽

Sean Crowther ◽

Marilyn Cree

Keyword(s):

Retrospective Review ◽

Femoral Fractures ◽

Atypical Femoral Fractures

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Comprehensive Study of the Risk Factors for Medication-Related Osteonecrosis of the Jaw Based on the Japanese Adverse Drug Event Report Database

Pharmaceuticals ◽

10.3390/ph13120467 ◽

2020 ◽

Vol 13 (12) ◽

pp. 467

Author(s):

Shinya Toriumi ◽

Akinobu Kobayashi ◽

Yoshihiro Uesawa

Keyword(s):

Risk Factors ◽

Side Effects ◽

Adverse Drug Event ◽

Femoral Fractures ◽

Principal Component ◽

Osteonecrosis Of The Jaw ◽

Drug Event ◽

Event Report ◽

Atypical Femoral Fractures ◽

Antiresorptive Agents

Medication-related osteonecrosis of the jaw (MRONJ) is associated with many drugs, including bisphosphonates (BPs). BPs are associated with atypical femoral fractures and osteonecrosis of the external auditory canal. Thus, many drugs are reported to cause adverse effects on bone. This study aimed to investigate the effects of drugs and patient backgrounds regarding osteonecrosis-related side effects, including MRONJ. This study used a large voluntary reporting database, namely, the Japanese Adverse Drug Event Report database. First, we searched for risk factors related to MRONJ using volcano plots and logistic regression analysis. Next, we searched for bone-necrosis-related side effects using principal component and cluster analysis. Factors that were significantly associated with MRONJ included eight types of BPs and denosumab, prednisolone, sunitinib, eldecalcitol, raloxifene, letrozole, doxifluridine, exemestane, radium chloride, medroxyprogesterone, female, elderly, and short stature. Furthermore, antiresorptive agents (i.e., BPs and denosumab) tended to induce MRONJ and atypical femoral fractures by affecting osteoclasts. We believe these findings will help medical personnel manage the side effects of many medications.

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