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Surgical Fixation of Atypical Femur Fractures in Bisphosphonate-treated Patients

Objective To evaluate the outcomes of the surgical fixation of atypical femoral fractures in bisphosphonate-treated patients with an intramedullary device. Materials and methods This multicentric study was carried out at the department of orthopedics, Dr. Ruth Phau Civil Hospital and Medicare Hospit...

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Autores principales: Rajput, Irfan Muhammad, Kumar, Jagdesh, Siddiqui, Adeel A, Jamil, Muhammad, Soughat, Muhammad, Ahmed, Malik W
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636699/
https://www.ncbi.nlm.nih.gov/pubmed/31333916
http://dx.doi.org/10.7759/cureus.4690
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author Rajput, Irfan Muhammad
Kumar, Jagdesh
Siddiqui, Adeel A
Jamil, Muhammad
Soughat, Muhammad
Ahmed, Malik W
author_facet Rajput, Irfan Muhammad
Kumar, Jagdesh
Siddiqui, Adeel A
Jamil, Muhammad
Soughat, Muhammad
Ahmed, Malik W
author_sort Rajput, Irfan Muhammad
collection PubMed
description Objective To evaluate the outcomes of the surgical fixation of atypical femoral fractures in bisphosphonate-treated patients with an intramedullary device. Materials and methods This multicentric study was carried out at the department of orthopedics, Dr. Ruth Phau Civil Hospital and Medicare Hospital, Karachi, Pakistan, between 2013 and 2018. In this retrospective observational study, we reviewed 10 bisphosphonate-treated patients, fixed surgically with an intramedullary nail after presenting with radiologically characteristic atypical femur fractures identified according to the American Society for Bone and Mineral Research criteria. We excluded patients with fractures sustained by high-energy trauma, road traffic accidents, fall from a height, and those associated with underlying malignancy. Results A total of 11 atypical femoral fractures in 10 patients were included, all of whom were females with a mean age of 68.6 (range 57-82) years. Out of 11 fractures, 81.8% (n=9) were located in the subtrochanteric region and two were located in the femoral shaft. The mean bisphosphonate use was 58.3 months. All patients were treated with intramedullary devices; an intramedullary interlocking nail in two cases and proximal femoral nail antirotation in nine cases. The mean follow-up duration was 12 months. All fractures were united in an average time of 9.9 months (range 6 - 16 months). Implant failure and/or nonunion were not observed, whereas delayed union was noted in five patients. Conclusion Intramedullary fixation is a reliable method for the treatment of atypical femur fractures in bisphosphonate-treated patients owing to its intramedullary placement. These devices act as an internal splint and can provide much more axial stability, reducing the risk of implant fatigue failure due to a delay in fracture healing from prolonged bisphosphonate use.
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spelling pubmed-66366992019-07-22 Surgical Fixation of Atypical Femur Fractures in Bisphosphonate-treated Patients Rajput, Irfan Muhammad Kumar, Jagdesh Siddiqui, Adeel A Jamil, Muhammad Soughat, Muhammad Ahmed, Malik W Cureus Orthopedics Objective To evaluate the outcomes of the surgical fixation of atypical femoral fractures in bisphosphonate-treated patients with an intramedullary device. Materials and methods This multicentric study was carried out at the department of orthopedics, Dr. Ruth Phau Civil Hospital and Medicare Hospital, Karachi, Pakistan, between 2013 and 2018. In this retrospective observational study, we reviewed 10 bisphosphonate-treated patients, fixed surgically with an intramedullary nail after presenting with radiologically characteristic atypical femur fractures identified according to the American Society for Bone and Mineral Research criteria. We excluded patients with fractures sustained by high-energy trauma, road traffic accidents, fall from a height, and those associated with underlying malignancy. Results A total of 11 atypical femoral fractures in 10 patients were included, all of whom were females with a mean age of 68.6 (range 57-82) years. Out of 11 fractures, 81.8% (n=9) were located in the subtrochanteric region and two were located in the femoral shaft. The mean bisphosphonate use was 58.3 months. All patients were treated with intramedullary devices; an intramedullary interlocking nail in two cases and proximal femoral nail antirotation in nine cases. The mean follow-up duration was 12 months. All fractures were united in an average time of 9.9 months (range 6 - 16 months). Implant failure and/or nonunion were not observed, whereas delayed union was noted in five patients. Conclusion Intramedullary fixation is a reliable method for the treatment of atypical femur fractures in bisphosphonate-treated patients owing to its intramedullary placement. These devices act as an internal splint and can provide much more axial stability, reducing the risk of implant fatigue failure due to a delay in fracture healing from prolonged bisphosphonate use. Cureus 2019-05-17 /pmc/articles/PMC6636699/ /pubmed/31333916 http://dx.doi.org/10.7759/cureus.4690 Text en Copyright © 2019, Rajput et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Orthopedics
Rajput, Irfan Muhammad
Kumar, Jagdesh
Siddiqui, Adeel A
Jamil, Muhammad
Soughat, Muhammad
Ahmed, Malik W
Surgical Fixation of Atypical Femur Fractures in Bisphosphonate-treated Patients
title Surgical Fixation of Atypical Femur Fractures in Bisphosphonate-treated Patients
title_full Surgical Fixation of Atypical Femur Fractures in Bisphosphonate-treated Patients
title_fullStr Surgical Fixation of Atypical Femur Fractures in Bisphosphonate-treated Patients
title_full_unstemmed Surgical Fixation of Atypical Femur Fractures in Bisphosphonate-treated Patients
title_short Surgical Fixation of Atypical Femur Fractures in Bisphosphonate-treated Patients
title_sort surgical fixation of atypical femur fractures in bisphosphonate-treated patients
topic Orthopedics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636699/
https://www.ncbi.nlm.nih.gov/pubmed/31333916
http://dx.doi.org/10.7759/cureus.4690
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