Predicting Need for Fixation of Atypical Femoral Fracture

Lee, Yong Seuk; Ha, Yong‐Chan; Kang, Bun Jung; Chang, Jae Suk; Koo, Kyung‐Hoi

doi:10.1210/jc.2012-4322

Cited by 30 publications

(19 citation statements)

References 26 publications

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“…Focal marrow, endosteal, or periosteal edema may be seen at MR imaging. Subtrochanteric fracture location has also been shown to correlate with the ultimate need for surgical fixation (73), although the literature is inconclusive. Close clinical and imaging surveillance during a trial of conservative therapy may be used in minimally symptomatic patients, although prophylactic fixation of incomplete fractures is most often used due to the high failure rate of conservative therapy (70).…”

Section: Figure 24mentioning

confidence: 99%

Proximal Femoral Fractures: What the Orthopedic Surgeon Wants to Know

et al. 2015

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Each year, more than 250,000 hip fractures occur in the United States, resulting in considerable patient mortality and morbidity. The various types of adult proximal femoral fractures require different treatment strategies that depend on a variety of considerations, including the location, morphologic features, injury mechanism, and stability of the fracture, as well as the patient's age and baseline functional status. The authors discuss femoral head, femoral neck, intertrochanteric, and subtrochanteric fractures in terms of injury mechanisms, specific anatomic and biomechanical features, and important diagnostic and management considerations, including the diagnostic utility of imaging modalities. The authors review clinically important classification systems, such as the Pipkin, Garden, Pauwels, and Evans-Jensen classification systems, with emphasis on differentiating subchondral insufficiency fractures from avascular necrosis of the femoral head and typical subtrochanteric fractures from atypical (often bisphosphonate-related) subtrochanteric fractures. In addition, the authors describe the potential complications and management strategies for each fracture type on the basis of the patient's age and physical condition. A clear understanding of these considerations allows the radiologist to better provide appropriate and relevant diagnostic information and management guidance to the orthopedic surgeon.

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Section: Figure 24mentioning

confidence: 99%

Proximal Femoral Fractures: What the Orthopedic Surgeon Wants to Know

et al. 2015

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“…Lin et al [22] reported that mean union time after surgical nailing for AFFs was shorter (mean, 4.5 months; range, 4-5 months) for four fractures with discontinuation of alendronate and administration of boneforming agents (TPTD for one fracture; strontium ranelate for three fractures) than for six fractures with continuation of alendronate after surgery (mean, 23.5 months; range, 18-31 months). TPTD has also been suggested as a nonsurgical intervention for AFF [14,16]. Chiang et al [13] reported that TPTD use was associated with increased bone remodeling in patients with AFF.…”

Section: Discussionmentioning

confidence: 99%

“…A randomized clinical trial suggested a role for TPTD in accelerating healing for fractures of the distal radius in postmenopausal women [12]. TPTD is, thus, expected to see use in the treatment of AFF [13,14]. Recent sporadic case reports and case series have associated discontinuation of bisphosphonate therapy and initiation of TPTD treatment with healing of AFFs [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Healing of bisphosphonate-associated atypical femoral fractures in patients with osteoporosis: a comparison between treatment with and without teriparatide

Miyakoshi

Aizawa

Sasaki³

et al. 2014

J Bone Miner Metab

100

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Atypical femoral fracture (AFF) often appears with bisphosphonate use. Teriparatide (TPTD) treatment may promote AFF healing, but few controlled or comparative studies have examined the effects of TPTD on healing of bisphosphonate-associated AFF. We retrospectively reviewed the medical records of 45 consecutive AFFs in 34 Japanese patients who had received oral bisphosphonates (alendronate or risedronate) for osteoporosis before AFF and had been followed for ≥12 months (range, 12-90 months). Thirty-seven complete or incomplete AFFs (82 %) were treated surgically and eight incomplete AFFs (18 %) were treated conservatively. Bisphosphonates were stopped at diagnosis. Based on TPTD use after fracture, AFFs were divided into non-TPTD (n = 24) and TPTD (n = 21) groups. Time to fracture-healing and frequency of delayed healing or non-union were compared between groups. Because fracture type (complete or incomplete) differed significantly between groups, only subanalyses for all surgically treated AFFs (complete and incomplete), surgically treated complete AFFs, and conservatively treated incomplete AFFs were performed. In subanalyses for all AFFs treated surgically, mean (± standard deviation) time to fracture healing was significantly better in the TPTD group (5.4 ± 1.5 months) than in the non-TPTD group (8.6 ± 4.7 months; P = 0.012), and the frequency of delayed healing or non-union was significantly lower in the TPTD group than in the non-TPTD group (P = 0.014). Subanalyses for surgically treated complete AFFs yielded similar results, but subanalyses for incomplete AFFs treated conservatively showed no significant differences between groups. TPTD treatment appears to significantly shorten the postoperative time to fracture healing and reduce rates of delayed healing or non-union after bisphosphonate-associated AFF.

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“…Despite a market size that is substantially less than most quaternary centers, we were able to evaluate, and more importantly, treat a significant number of these fractures. Lee et al 29 reported on 51 patients with 65 incomplete fractures seen at four different tertiary centers during a similar time period (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011). This adds to the evidence that as the number of patients receiving bisphosphonates increases in our communities, a parallel increase in the incidence of these fractures should be expected to present to tertiary care facilities.…”

Section: Discussionmentioning

confidence: 99%