J Korean Orthop Assoc.  2013 Jun;48(3):185-189. 10.4055/jkoa.2013.48.3.185.

Surgical Treatment of Atypical Femoral Fracture

• Lee KJ
• Kwon YW
• Ha YC
• Lee YK
• Kim BS
• Min BW

• KMID: 2106671
• DOI: http://doi.org/10.4055/jkoa.2013.48.3.185

Abstract

Bisphosphonates have been used as first-line therapy to reduce the incidence of osteoporotic fractures. Several publications have recently described the occurrence of low-energy subtrochanteric and femoral shaft fractures with long-term bisphosphonate use, so called atypical femoral fracture. Atypical fracture is a rare condition, and the treatment and its effectiveness have not been adequately reported. Thus, finding appropriate treatment is difficult. In this report, the authors reviewed the treatment of atypical fracture and described helpful suggestions for surgery.

Keyword

femoral fracture; bisphosphonate

MeSH Terms

Diphosphonates
Femoral Fractures
Incidence
Osteoporotic Fractures
Diphosphonates

Figure

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  Figure 1 Anterior (A) and lateral (B) radiographs of the femur show unique configuration of bisphosphonate-associated femoral fractures: (1) lateral intramedullary cortical thickening; (2) transverse or slight obliquity; (3) medial spike; and (4) minimal comminution.

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  Figure 2 (A, B) In situations where a nail cannot be used, such as with an extremely narrow canal, plating can be performed.

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  Figure 3 (A) The angular stable locking system (ASLS) consists of a screw with three outer diameters and a resorbable sleeve (black arrow). (B) A standard locking screw (black arrow) and ASLS screw (white arrow).

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  Figure 4 (A) Anteroposterior (AP) radiograph of the right femur obtained following intramedullary nailing. (B) AP radiograph of the left femur shows lateral bowing of the femoral shaft. (C) Whole body bone scan shows leg length discrepancy following surgery.

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  Figure 5 Anteroposterior radiograph of the pelvis shows complete fracture of left subtrochanter and incomplete fracture (white arrow) of right subtrochanter.

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