Specific Features Associated with Femoral Shaft Fractures Caused by Low-Energy Trauma

Salminen, Sari; Pihlajamäki, Harri; Avikainen, Veikko; Kyrö, Antti; Böstman, O

doi:10.1097/00005373-199707000-00027

Cited by 59 publications

(28 citation statements)

References 12 publications

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“…However, there is evidence that torsional forces may be involved in many periprosthetic fractures, suggesting torsional loading is pre-eminent in causing periprosthetic femur fracture [30]. A review of femoral shaft fractures caused by low-energy trauma treated over a 10-year period found 58% had a spiral fracture pattern, indicating a torsional mechanism for the fracture [26]. Studies have noted high torsional forces Fig.…”

Section: Discussionmentioning

confidence: 99%

Does Femoral Component Loosening Predispose to Femoral Fracture?: An In Vitro Comparison of Cemented Hips

Harris

Owen

Wayne

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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The incidence of femur fracture around total hip arthroplasties continues to increase at substantial cost to society. These fractures are frequently associated with a loose femoral component. Consequently, we sought to test whether femoral component loosening predisposes to periprosthetic femoral fracture. Because many periprosthetic femoral fractures are spiral in nature, we evaluated the torsional characteristics of the implanted femur in which the only design variable was instability of the femoral component. We used synthetic (polyurethane) (n = 15) and paired cadaveric femora (n = 10) with specimens divided into two groups: well-fixed and loose cemented stems. Each specimen was tested mechanically in internal rotation until failure. For the synthetic specimens, torque to failure was reduced by 38%, whereas stiffness was decreased 54% for the loose group compared with the well-fixed group. For the cadaveric specimens, torque to failure was reduced by 58%, whereas stiffness decreased 70% for the loose group compared with the wellfixed group. Fracture patterns were similar between synthetic and cadaveric femora with a proximal spiral pattern in loose specimens and more distal fracture patterns with well-fixed stems. Based on our data, patients with loosened femoral components are at risk for fracture at a substantially lower torque than those with well-fixed components.

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Section: Discussionmentioning

confidence: 99%

Does Femoral Component Loosening Predispose to Femoral Fracture?: An In Vitro Comparison of Cemented Hips

Harris

Owen

Wayne

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…In a study from Finland, some specific features of the low-energy femoral shaft fractures which occurred between 1985 and 1994 were described in 50 patients. 87 In this report, bisphosphonate treatment was not considered as a predisposing factor of this type of fracture and very likely no patient of this study was a bisphosphonate user. However, the majority of patients with low-energy femoral shaft fracture had one or more predisposing factors, such as diabetes mellitus, chronic corticosteroid treatment for pulmonary disease or rheumatoid arthritis, and severe osteoarthritis of the ipsilateral hip or knee.…”

Section: Atypical Fractures Of the Femoral Diaphysismentioning

confidence: 91%

“…The latter figure indicates that in the elderly one out of 400 fractures is a low-energy femoral shaft fracture. 87 The authors concluded that a typical lowenergy fracture of the femoral shaft is a closed spiral fracture with minimal comminution in the middle third of the left femur of an aged woman, with a high rate of postoperative complications. It seems that the pattern of the femoral shaft fractures in patients on long-term alendronate therapy described by Goh et al 84 and Kwek et al 86 is different from that of the femoral shaft fractures occurring in non-users of bisphosphonates.…”

Section: Atypical Fractures Of the Femoral Diaphysismentioning

confidence: 99%

Bisphosphonate-associated adverse events

Papapetrou

2009

253

174

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The adverse events of the nitrogen-containing bisphosphonates are reviewed. Oral bisphosphonates (alendronate, risedronate and ibandronate), mainly used for the treatment of osteoporosis, have been associated with adverse events from the upper gastrointestinal tract, acute phase response, hypocalcaemia and secondary hyperparathyroidism, musculoskeletal pain, osteonecrosis of the jaw and ocular events. Intravenous bisphosphonates (pamidronate, ibandronate and zoledronic acid), used in oncology and for the treatment of osteoporosis, have been associated with all the above adverse events, except those from the upper gastrointestinal tract. Moreover, pamidronate and zoledronic acid have been associated with renal toxicity. Association of bisphosphonates with atrial fibrillation and atypical fractures of the femoral diaphysis remains uncertain. There are a few case reports relating bisphosphonates to cutaneous reactions, oral ulcerations, hepatitis and esophageal cancer. Generally, intravenous are more potent than oral bisphosphonates and the frequency and severity of some of the bisphosphonate-associated adverse events are dose and potency dependent.

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“…Fractures located in the subtrochanteric region or femoral shaft (diaphysis) account for 7% to 10% of all hip/femoral diaphyseal fractures. (73,74) Approximately 75% of complete subtrochanteric and femoral shaft fractures are associated with major trauma such as motor vehicle accidents, (73) in which the energy transmitted to the bone results in the propagation of multiple fracture lines, thus producing comminution. Especially in older patients, femoral shaft fractures may occur below the stem of the prosthesis after total hip replacement.…”

Section: Epidemiology Of Subtrochanteric and Femoral Shaft Fracturesmentioning

confidence: 99%

“…(75) In adults of all ages, more than half of femoral shaft fractures are spiral fractures, with the remainder presenting with a transverse or oblique configuration. (73,76) Subtrochanteric fractures have important effects on mortality and morbidity. A study of 87 patients with subtrochanteric fractures showed a mortality rate of 14% at 12 months and 25% at 24 months.…”

Section: Epidemiology Of Subtrochanteric and Femoral Shaft Fracturesmentioning

confidence: 99%

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

Shane

Burr

Ebeling

et al. 2010

Journal of Bone and Mineral Research

988

679

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Reports linking long-term use of bisphosphonates (BPs) with atypical fractures of the femur led the leadership of the American Society for Bone and Mineral Research (ASBMR) to appoint a task force to address key questions related to this problem. A multidisciplinary expert group reviewed pertinent published reports concerning atypical femur fractures, as well as preclinical studies that could provide insight into their pathogenesis. A case definition was developed so that subsequent studies report on the same condition. The task force defined major and minor features of complete and incomplete atypical femoral fractures and recommends that all major features, including their location in the subtrochanteric region and femoral shaft, transverse or short oblique orientation, minimal or no associated trauma, a medial spike when the fracture is complete, and absence of comminution, be present to designate a femoral fracture as atypical. Minor features include their association with cortical thickening, a periosteal reaction of the lateral cortex, prodromal pain, bilaterality, delayed healing, comorbid conditions, and concomitant drug exposures, including BPs, other antiresorptive agents, glucocorticoids, and proton pump inhibitors. Preclinical data evaluating the effects of BPs on collagen cross-linking and maturation, accumulation of microdamage and advanced glycation end products, mineralization, remodeling, vascularity, and angiogenesis lend biologic plausibility to a potential association with long-term BP use. Based on published and unpublished data and the widespread use of BPs, the incidence of atypical femoral fractures associated with BP therapy for osteoporosis appears to be very low, particularly compared with the number of vertebral, hip, and other fractures that are prevented by BPs. Moreover, a causal association between BPs and atypical fractures has not been established. However, recent observations suggest that the risk rises with increasing duration of exposure, and there is concern that lack of awareness and underreporting may mask the true incidence of the problem. Given the relative rarity of atypical femoral fractures, the task force recommends that specific diagnostic and procedural codes be created and that an international registry be established to facilitate studies of the clinical and genetic risk factors and optimal surgical and medical management of these fractures. Physicians and patients should be made aware of the possibility of atypical femoral fractures and of the potential for bilaterality through a change in labeling of BPs. Research directions should include development of animal models, increased surveillance, and additional epidemiologic and clinical data to establish the true incidence of and risk factors for this condition and to inform orthopedic and medical management. ß

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Specific Features Associated with Femoral Shaft Fractures Caused by Low-Energy Trauma

Cited by 59 publications

References 12 publications

Does Femoral Component Loosening Predispose to Femoral Fracture?: An In Vitro Comparison of Cemented Hips

Does Femoral Component Loosening Predispose to Femoral Fracture?: An In Vitro Comparison of Cemented Hips

Bisphosphonate-associated adverse events

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

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