Koh, A, Guerado, E and Giannoudis, PV (2017) Atypical femoral fractures related to bisphosphonate treatment. The Bone & Joint Journal, 99-B (3). pp. 295-302. ISSN 2049-4394
Abstract
Aims: Treatment guidelines for atypical femoral fractures associated with bisphosphonates have not been established. We conducted a systematic review of the treatment of atypical femoral fractures first, to evaluate the outcomes of surgical fixation of complete atypical fractures and secondly, to assess whether prophylactic surgery is necessary for incomplete atypical fractures.
Materials and Methods: Case reports and series were identified from the PubMed database and were included if they described the treatment of atypical femoral fractures. In total, 77 publications met our inclusion criteria and 733 patients with 834 atypical complete or incomplete femoral fractures were identified.
Results: For complete fractures, internal fixation was predominantly achieved by intramedullary nailing. The mean time to healing post-operatively was 7.3 months (2 to 31). Revision surgery for nonunion or implant failure was needed in 77 fractures (12.6%). A greater percentage of fractures treated with plate fixation (31.3%) required revision surgery than those treated with intramedullary nailing (12.9%) (p < 0.01).
Non-operative treatment of incomplete fractures failed and surgery was eventually needed in nearly half of the patients (47%), whereas prophylactic surgery was successful and achieved a 97% rate of healing.
Conclusion: Intramedullary nailing is the first-line treatment for a complete fracture, although the risk of delayed healing and revision surgery seems to be higher than with a typical femoral fracture. Non-operative treatment does not appear to be a reliable way of treating an incomplete fracture: prophylactic intramedullary nailing should be considered if the patient is in intractable pain. Radiographs of the opposite side should be obtained routinely looking for an asymptomatic fracture. Bisphosphonates must be discontinued but ongoing metabolic management in the form of calcium and/or vitamin D supplements is advisable. Teriparatide therapy can be considered as an alternative treatment.
Cite this article: Bone Joint J 2017;99-B:295–302.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Keywords: | Bisphosphonate; Atypical femoral fracture; Surgical management; Prophylactic surgery; Non-operative treatment |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) > Orthopaedics (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 22 Oct 2018 14:59 |
Last Modified: | 22 Oct 2018 14:59 |
Status: | Published |
Publisher: | British Editorial Society of Bone and Joint Surgery |
Identification Number: | 10.1302/0301-620X.99B3.BJJ-2016-0276.R2 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:137555 |