Patients with atypical femoral fractures: characteristics, anabolic treatment and long term follow-up

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.

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Uncemented extensive porous titanium-coated long femoral stem prostheses are effective in treatment of Vancouver type B2 periprosthetic femoral fractures: A retrospective mid- to long-term follow-up study

Journal of Orthopaedic Surgery ◽

10.1177/2309499019857653 ◽

2019 ◽

Vol 27 (2) ◽

pp. 230949901985765 ◽

Cited By ~ 2

Author(s):

Qiuru Wang ◽

Donghai Li ◽

Pengde Kang

Keyword(s):

Femoral Stem ◽

Femoral Fractures ◽

Porous Titanium ◽

Follow Up Study ◽

Periprosthetic Femoral Fractures ◽

Long Term Follow Up

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Fraturas Atípicas do Fémur Associadas a Terapêutica Prolongada com Bisfosfonatos

Acta Médica Portuguesa ◽

10.20344/amp.4323 ◽

2013 ◽

Vol 26 (6) ◽

pp. 746

Author(s):

Francisco Flores Santos ◽

José Pinheiro da Silva ◽

Paulo Felicíssimo

Keyword(s):

Femoral Fracture ◽

Scientific Evidence ◽

Femoral Fractures ◽

Osteoporotic Fractures ◽

Femoral Shaft ◽

Term Treatment ◽

Atypical Femoral Fractures ◽

Long Term Treatment

Introduction: Long-term treatment with bisphosphonates has been associated to atypical femoral fractures whose features are now clearly defined.Clinical Cases: We present two cases of female patients under bisphosphonate treatment for over 10 years who were admitted to our institution for subtrochanteric and femoral shaft fractures after low-energy trauma. They presented, respectively, a transverse and a short oblique femoral fracture, with thickening of the lateral cortex. They underwent surgical treatment obtaining good functional and imaging result.Discussion: These cases fulfill the established criteria for atypical femoral fracture, thereby illustrating a serious adverse event of long-term treatment with bisphosphonates. Such relationship has still not been clearly established by scientific evidence. However, its effectiveness in preventing osteoporotic fractures is well proven.Conclusion: The atypical femoral fractures are possibly a serious adverse effect of the long-term treatment with bisphosphonates. Scientific evidence still supports its use, however, the physician must be aware of these events and closely follow-up these patients.

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Atypical Femoral Fractures due to long-term bisphosphonates therapy

Romanian Journal of Orthopaedic Surgery and Traumatology ◽

10.2478/rojost-2019-0005 ◽

2019 ◽

Vol 2 (1) ◽

pp. 23-27

Author(s):

Ioan Mihai Japie ◽

Radu Rădulescu ◽

Adrian Bădilă ◽

Ecaterina-Maria Japie ◽

Alexandru Papuc ◽

...

Keyword(s):

Intramedullary Nail ◽

Femoral Fractures ◽

Gamma Nail ◽

Atypical Femoral Fractures ◽

Non Union ◽

Female Patients ◽

Number Of Patients ◽

Long Term Treatment

AbstractIntroduction. Bisphosphonates (BPs) represent the main therapy in patients with osteoporosis, although a long-term treatment can lead to atypical fractures.Material and methods. We conducted a retrospective study between 2008 and 2017 and included 23 female patients with atypical femoral fractures (AFFs). The mean period of BPs therapy administration was 5.2 years. We included 7 subtrochanteric fractures and 18 femoral shaft fractures. Two of the total patients presented bilateral femoral fractures. 18 patients presented prodromal symptoms from 2 to 18 months before the diagnosis of fractures, all of them following low energy trauma. All the patients included in our study underwent surgery with intramedullary nail or gamma nail. The postoperative mean follow-up was 2 years. Results. Of all 23 female patients with a total of 25 fractures – 10 underwent osteosynthesis with gamma nail and 15 underwent osteosynthesis with intramedullary nail. From the total number of patients: 13 patients achieved complete union, 6 presented delayed union and 3 non-union (2 intramedullary nail and one gamma nail), whereas in one patient treated previously with gamma nail we observed implant failure.Conclusion. The treatment of AFFs after BPs therapy administration represents a challenge for orthopaedic surgeons regarding both surgical technique and postoperative follow-up.

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Treatment of bicondylar femoral fractures complicated by concurrent ligament or tendon injuries in four dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-14-01-0003 ◽

2014 ◽

Vol 27 (04) ◽

pp. 324-332 ◽

Cited By ~ 2

Author(s):

G. H. Frydman ◽

L. C. Cuddy ◽

S. E. Kim ◽

A. Pozzi

Keyword(s):

Physical Examination ◽

Cruciate Ligament ◽

Force Plate ◽

Femoral Fractures ◽

Tendon Injuries ◽

Anatomical Reduction ◽

Long Term Follow Up ◽

Plate Analysis

SummaryObjective: Retrospective case series describing the surgical treatment and outcome in dogs with bicondylar femoral fractures complicated by ligament or tendon injuries.Methods: Medical records were reviewed for three immature and one mature dog with traumatic bicondylar fractures of the distal femur and concurrent ligament or tendon injury treated surgically. Data retrieved included physical examination, imaging, and treatment. Long-term follow-up and return to function was assessed by owner feedback, physical examination, radiology, and force plate analysis. The immediate, four-week, and two-year postoperative outcomes were described.Results: All four dogs were presented with injuries to either the cranial or caudal cruciate ligament. Only two dogs underwent surgical repair of the caudal cruciate ligament. Anatomical reduction and rigid internal fixation of the distal femoral fractures was performed using a combination of lag screws, Kirschner wires, and bone plates. At the long-term follow-up, all cases had good to excellent return to function, as assessed by force plate analysis and owner assessment of quality of life and satisfaction. Radiographs revealed evidence of complete fracture healing, with moderate to severe osteoarthritis of the stifle.Clinical significance: Bicondylar femoral fractures can be associated with ligament or tendon injuries. Anatomical reduction and internal fixation of bicondylar femoral fractures is recommended and may offer a good to excellent return function, with or without repair of associated caudal cruciate ligament injuries.

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Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

Behavioral and Brain Sciences ◽

10.1017/s0140525x1800105x ◽

2019 ◽

Vol 42 ◽

Cited By ~ 2

Author(s):

John P. A. Ioannidis

Keyword(s):

Mental Health ◽

Mental Disease ◽

Brain Disorders ◽

Social Stressors ◽

Labor Education ◽

Mental Diseases ◽

Long Term Follow Up ◽

Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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