Characteristic features and surgical outcome in bisphosphonate-associated atypical femoral fracture: A retrospective observational study

Document Type : Original Article

Authors

Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background: Bisphosphonate-associated atypical femoral fracture (AFF) is a rare and serious condition with poorly understood characteristics and management.
 
Objectives: This study aimed to evaluate the characteristic features and outcomes of AFF in a two-center cohort study.
 
Methods: In this retrospective survey, the medical records of 22 AFF patients were reviewed, who have used alendronate for > 12 months. The demographic characteristics (e.g., age, gender, and body mass index), clinical features (e.g., symptoms and symptom duration), radiologic characteristics (e.g., fracture site, the severity of the fracture, and contralateral involvement), surgical characteristics (e.g., the type of surgery union period), and postoperative complications (e.g., fixation failure and union problems) were extracted from the patients’ profiles.
 
Results: The study population included 4 males and 18 females with a mean age of ‎70.6±11.9 ‎‏ ‏years. ‏The mechanism ‎of fracture was falling‎ in 21 (95.5%) patients. The mean duration of ‏bisphosphonate consumption was estimated at ‏‎3.8±2 ‎years. Prodromal symptoms (pain and limping) were recorded in 12 (54.55%) ‏patients. ‏The fractures were in the femoral shaft and subtrochanteric in 15 (68.2%) and 7 (‏‏31.8%) patients, respectively. ‏The fixation device was  ‏the ‎intramedullary nail and plate in 18 (81.8%) and 4 (18.2%) patients, respectively. ‏The mean union period was obtained at ‏‎8.3±2.8 ‎months. Union complications (delayed or ‏nonunion) occurred in 6 (27.3%) patients. It was reported that fixation failed in 5 (22.7%) patients, including 3 nails and 2 ‏plate fixations.
‏
Conclusions: Based on the results, AFF was associated with a prolonged union. ‏The intramedullary nail provided a more secure fixation. Prodromal symptoms could be used for earlier detection of patients. ‏

Keywords

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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Razavi International Journal of Medicine
Volume 9, Issue 4
October 2021
Pages 1-5

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