Bilateral atypical femoral fractures: how much symmetry is there on imaging?

Probyn, Linda; Cheung, Angela M.; Lang, Catherine; Lenchik, Leon; Adachi, Jonathan D.; Khan, Aliya; Josse, Robert G.; Tomlinson, George; Bleakney, Robert

doi:10.1007/s00256-015-2212-7

Cited by 26 publications

(19 citation statements)

References 16 publications

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“…In this study, every case had multiple risk factors associated with medical conditions and medication history. However, there was no case that had curvature of the femoral diaphysis, as shown in Figures 1-4 [12]. In this study, the 3 Case Reports in Orthopedics patient described in Case 1 first experienced her right femoral "subtrochanteric" fracture and later the left femoral "diaphyseal" fracture; this seems a relatively rare case.…”

Section: Discussionmentioning

confidence: 57%

“…Probyn et al reported a strong correlation between bilateral AFF locations, with 58 of 76 (76.3%) occurring within <5 cm and 41 of 76 (53.9%) within ≤2.5 cm. They concluded that bilateral AFFs commonly have similar imaging features, including location along the femur [ 12 ]. In this study, the patient described in Case 1 first experienced her right femoral “subtrochanteric” fracture and later the left femoral “diaphyseal” fracture; this seems a relatively rare case.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Features and Outcomes of Bilateral Atypical Femoral Fractures

Hamahashi

Noguchi

Uchiyama

et al. 2020

Case Reports in Orthopedics

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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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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Clinical Features and Outcomes of Bilateral Atypical Femoral Fractures

Hamahashi

Noguchi

Uchiyama

et al. 2020

Case Reports in Orthopedics

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“…5 The 25% reduction in com posite outcomes of serious neonatal morbidity is limited by the unclear effect on outcomes such as respiratory distress syndrome and intraven tricular hemorrhage. …”

Section: A Single Course Of "Rescue" Corticosteroids May Be Consideredmentioning

confidence: 99%

Antenatal corticosteroids

Kfouri

D’Souza

2017

CMAJ

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A single course of antenatal corticosteroids should be offered to all women at risk of delivery between 24 and 34 weeks Antenatal corticoster oids accelerate fetal lung maturation and reduce rates of neonatal death, respiratory distress syndrome, intraventricular hemorrhage and early neonatal infections. These benefits are seen in neo nates born up to seven days after the first dose 1 (Box 1). 2A single course of antenatal corticosteroids may be considered in women at risk of delivery between 34-36 and 22-24 weeksA recent randomized controlled trial showed that antenatal cortico steroids reduce neonatal respiratory complications among women at risk of delivery between 34 weeks 0 days and 36 weeks 6 days (the number needed to treat to prevent one case of severe respiratory morbidity was 25).2 Among women at risk of imminent delivery between 22 weeks 0 days and 24 weeks 0 days who choose perinatal resuscitation, a metaanalysis of cohort studies suggested that antenatal corticosteroids may reduce the risk of neonatal inhospital mortality by 52%. 3The benefits of antenatal corticosteroids outweigh the risks A single course of antenatal corticosteroids between 24 and 34 weeks is associated with a reduced risk of cerebral palsy and severe disability 4 with out an increase in maternal infections.1 However, neonatal hypo glycemia has been observed when antenatal corticosteroids are administered after 34 weeks.2 Adults exposed to antenatal corticosteroids in utero have higher rates of insulin resistance (but not diabetes). A single course of "rescue" corticosteroids may be consideredA single additional course of antenatal corticosteroids can be considered, after specialist consultation, in women still at risk of preterm delivery seven days after completing the initial course.5 The 25% reduction in com posite outcomes of serious neonatal morbidity is limited by the unclear effect on outcomes such as respiratory distress syndrome and intraven tricular hemorrhage. Although repeated (more than two) courses of antenatal corticosteroids are associated with improvements in shortterm respiratory morbidity, the unclear safety profile of repeated courses (including a possible birthweight reduction) precludes their routine use.

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“…Meanwhile radiological analyses and pedagogical guides to the recognition of various features of AFFs have also been published [17,24–29].…”

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confidence: 99%

Audit of Atypical Femoral Fractures and a Description of Some of Their Features

et al. 2016

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Hospital discharge coding misclassified a great majority of femoral fractures as subtrochanteric. As an essential criteria for diagnosing AFF is their subtrochanteric location, this misclassification impaired our ability to retrospectively search for AFF patients. Radiologists tended not to report AFF when typical radiographic characteristics were present. Bilateral and multifocal disease is of interest in pointing to the diagnosis and in suggesting that the mechanism of injury in respect of these unusual fractures is more complex than simple low-energy trauma.

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Bilateral atypical femoral fractures: how much symmetry is there on imaging?

Abstract: Patients with unilateral atypical femoral fractures are likely to be diagnosed with a contralateral AFF within the first year of presentation. Bilateral AFFs commonly have similar imaging features, including location along the femur.

Cited by 26 publications

References 16 publications

Clinical Features and Outcomes of Bilateral Atypical Femoral Fractures

Clinical Features and Outcomes of Bilateral Atypical Femoral Fractures

Antenatal corticosteroids

Audit of Atypical Femoral Fractures and a Description of Some of Their Features

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