Epidemiology and Clinical Features of Atypical Femoral Fractures

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.

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

Bone Abstracts ◽

10.1530/boneabs.3.pp333 ◽

2014 ◽

Author(s):

Liana Tripto-Shkolnik ◽

Anat Jaffe

Keyword(s):

Femoral Fractures ◽

Atypical Femoral Fractures ◽

Anabolic Treatment ◽

Long Term Follow Up

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Bilateral atypical femoral fractures after only 4-years of bisphosphonate therapy

Endocrine Abstracts ◽

10.1530/endoabs.50.p066 ◽

2017 ◽

Author(s):

Edouard Mills ◽

Pat Forbes ◽

Michael Yee ◽

Jeremy Cox ◽

Alexander N Comninos

Keyword(s):

Femoral Fractures ◽

Bisphosphonate Therapy ◽

Atypical Femoral Fractures

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Atypical femoral fractures in 2 children treated with bisphosphonates

10.26226/morressier.59020063d462b80292385bf1 ◽

2017 ◽

Author(s):

Benjamin Jacobs

Keyword(s):

Femoral Fractures ◽

Atypical Femoral Fractures

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Pathogenesis, Management and Prevention of Atypical Femoral Fractures

Journal of Bone Metabolism ◽

10.11005/jbm.2015.22.1.1 ◽

2015 ◽

Vol 22 (1) ◽

pp. 1 ◽

Cited By ~ 15

Author(s):

Gun-Il Im ◽

Seung-Hyo Jeong

Keyword(s):

Femoral Fractures ◽

Atypical Femoral Fractures

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Correction to: The clinical features, management options and complications of paediatric femoral fractures

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-021-02998-y ◽

2021 ◽

Author(s):

Sean Duffy ◽

Yael Gelfer ◽

Alex Trompeter ◽

Anna Clarke ◽

Fergal Monsell

Keyword(s):

Clinical Features ◽

Femoral Fractures ◽

Management Options

A correction to this paper has been published: https://doi.org/10.1007/s00590-021-02998-y

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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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