Factors Associated with Increased Healing Time in Complete Femoral Fractures After Long-Term Bisphosphonate Therapy

Lim, Hae-Seong; Kim, Chong-Kwan; Park, Youn-Soo; Moon, Young-Wan; Lim, Seung‐Jae; Kim, Sang-Min

doi:10.2106/jbjs.15.01422

Cited by 60 publications

(57 citation statements)

References 30 publications

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“…The second goal is to enhance the possibility of healing incomplete fractures. Reduced healing capacity of incomplete AFFs can partly be explained by biomechanical factors in which daily low-impact activities are enough to cause strains that prohibit bone formation [ 38 ]. Accordingly, we believe that the healing process may benefit if this strain were significantly reduced.…”

Section: Discussionmentioning

confidence: 99%

Lateral fixation: an alternative surgical approach in the prevention of complete atypical femoral fractures

Kharazmi

Michaëlsson

Hallberg

et al. 2017

Eur J Orthop Surg Traumatol

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Little evidence is available on how to treat incomplete atypical fractures of the femur. When surgery is chosen, intramedullary nailing is the most common invasive technique. However, this approach is adopted from the treatment of other types of ordinary femoral fracture and does not aim to prevent the impending complete fracture by interrupting the mechanism underlying the pathology. We suggest a different surgical approach that intends to counteract the underlying biomechanical conditions leading to a complete atypical fracture and thus could be better suited in selected cases. Here, we share an alternative surgical approach and present two cases treated accordingly.

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Section: Discussionmentioning

confidence: 99%

Lateral fixation: an alternative surgical approach in the prevention of complete atypical femoral fractures

Kharazmi

Michaëlsson

Hallberg

et al. 2017

Eur J Orthop Surg Traumatol

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“…Lim et al 49 tested 46 variables for association with healing time longer than six months or non-union. High BMI and subtrochanteric fracture location were significantly associated with delayed healing time, but these factors are not controllable.…”

Section: Surgical Treatment and Complicationsmentioning

confidence: 99%

The enigma of atypical femoral fractures

Larsen

Schmal

2018

EFORT Open Reviews

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Atypical femoral fractures (AFF) are stress or ‘insufficiency’ fractures, often complicated by the use of bisphosphonates or other bone turnover inhibitors. While these drugs are beneficial for the intact osteoporotic bone, they probably prevent a stress fracture from healing which thus progresses to a complete fracture.Key features of atypical femoral fractures, essential for the diagnosis, are: location in the subtrochanteric region and diaphysis; lack of trauma history and comminution; and a transverse or short oblique configuration.The relative risk of patients developing an atypical femoral fracture when taking bisphosphonates is high; however, the absolute risk of these fractures in patients on bisphosphonates is low, ranging from 3.2 to 50 cases per 100,000 person-years.Treatment strategy in patients with AFF involves: radiograph of the contralateral side (computed tomography and magnetic resonance imaging should also be considered); dietary calcium and vitamin D supplementation should be prescribed following assessment; bisphosphonates or other potent antiresorptive agents should be discontinued; prophylactic surgical treatment of incomplete AFF with cephalomedullary nail, unless pain free; cephalomedullary nailing for surgical fixation of complete fractures; avoidance of gaps in the lateral and anterior cortex; avoidance of varus malreduction.Cite this article: EFORT Open Rev 2018;3:494-500. DOI: 10.1302/2058-5241.3.170070.

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“…A single-center study of 109 AFFs was performed in Korea. 11) Bone union was achieved within 6 months in 76 AFFs (69.7% of the fractures), whereas there was nonunion in six AFFs (two patients underwent revision surgery and four declined further surgery). In the present study, bone union was achieved within 6 months in 3 of 13 AFFs (excluding case 8 with an incomplete fracture), so the rate was slightly lower at 31%.…”

Section: Discussionmentioning

confidence: 89%

Post-operative Rehabilitation of Atypical Femoral Fracture in a Single Center

Mizutani

Horiuchi

Nakamura

et al. 2020

PRM

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Increasing numbers of reports have described atypical femoral fracture (AFF) in patients being treated with oral bone resorption inhibitors, such as bisphosphonates. Most AFF patients undergo surgical treatment. However, there is little information about post-operative rehabilitation and patient activity levels after surgery for such fractures. Here we report the outcome of surgical treatment and postoperative rehabilitation for AFF at a single center in Japan. Methods: We retrospectively reviewed 13 patients (14 AFFs) who underwent surgery at Nagano Matsushiro General Hospital between January 2013 and December 2016. The clinical backgrounds of the patients were evaluated. Results: The patients comprised 1 man (1 AFF) and 12 women (13 AFFs). The mean age at surgery was 77.7±7.1 years (mean±SD). Before AFF occurred, 12 of the 13 patients had used bisphosphonates for osteoporosis. An intramedullary nail was inserted in all patients. Partial weight bearing was started on average 2 weeks after surgery, and full weight-bearing gait was permitted on average 3 weeks after surgery. The average time to bone union was 9.9±6.1 months, ranging from 3 to 23 months. None of the patients required additional surgical procedures, including revision surgery for pseudoarthrosis (nonunion) or delayed union. Before AFF, 12 patients walked independently, and 1 patient walked with a single cane. At the final follow-up (mean duration: 34.5±15.7 months), 8 patients could walk independently and 5 patients walked with a single cane. Conclusions: We recognized that rigid fixation for AFF supported early weight-bearing gait after surgery.

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Factors Associated with Increased Healing Time in Complete Femoral Fractures After Long-Term Bisphosphonate Therapy

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 60 publications

References 30 publications

Lateral fixation: an alternative surgical approach in the prevention of complete atypical femoral fractures

Lateral fixation: an alternative surgical approach in the prevention of complete atypical femoral fractures

The enigma of atypical femoral fractures

Post-operative Rehabilitation of Atypical Femoral Fracture in a Single Center

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