Hip Pelvis.  2017 Jun;29(2):127-132. 10.5371/hp.2017.29.2.127.

Lateral Femoral Bowing and the Location of Atypical Femoral Fractures

Affiliations
  • 1Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea. femur1973@gmail.com

Abstract

PURPOSE
Atypical femoral fractures (AFFs) occur in two distinct part, subtrochanter and diaphysis. The aim of this study was to investigate the relationship between the lateral femoral bowing angle and the location of AFF.
MATERIALS AND METHODS
This study included a total of 56 cases in 45 patients who underwent surgical treatment between January 2010 and December 2015. For the diaphyseal and subtrochanteric AFFs, we evaluated the relationship between the anatomic location and lateral femoral bowing angle. Lateral femoral bowing angle was measured by two orthopaedic surgeons and average value of two calibrators was used in statistic analysis. Other variables like age, height, weight, body mass index and bone mineral density were also evaluated. We also calculated the cutoff value for the location of the fractures from the raw data.
RESULTS
The average lateral femoral bowing angle was 10.10°±3.79° (3°-19°) in diaphyseal group and 3.33°±2.45° (1.5°-11°) in subtrochanter group. Lateral femoral bowing angle was statistically significant in logistic regression analysis. According to the receiver operating characteristic curve, cutoff value for the location of the fracture was 5.25°. In other words, the femoral diaphyseal fractures are more frequent if the lateral femoral bowing angle is greater than 5.25°.
CONCLUSION
The lateral femoral bowing angle is associated with the location of the AFFs and the cutoff value of lateral femoral bowing angle was 5.25°.

Keyword

Femur; Atypical fracture; Lateral bowing angle

MeSH Terms

Body Weight
Bone Density
Diaphyses
Femoral Fractures*
Femur
Humans
Logistic Models
ROC Curve
Surgeons

Figure

  • Fig. 1 Femoral bowing was measured as the angulation between the proximal and distal quarters of the femoral diaphysis.

  • Fig. 2 Receiver operating characteristic curve.


Reference

1. Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet. 1996; 348:1535–1541.
Article
2. Harris ST, Watts NB, Genant HK, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA. 1999; 282:1344–1352.
Article
3. McClung MR, Geusens P, Miller PD, et al. Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med. 2001; 344:333–340.
Article
4. Black DM, Delmas PD, Eastell R, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. 2007; 356:1809–1822.
Article
5. Chesnut CH 3rd, Skag A, Christiansen C, et al. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res. 2004; 19:1241–1249.
Article
6. Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005; 90:1294–1301.
Article
7. Thompson RN, Phillips JR, McCauley SH, Elliott JR, Moran CG. Atypical femoral fractures and bisphosphonate treatment: experience in two large United Kingdom teaching hospitals. J Bone Joint Surg Br. 2012; 94:385–390.
8. Kang JS, Won YY, Kim JO, et al. Atypical femoral fractures after anti-osteoporotic medication: a Korean multicenter study. Int Orthop. 2014; 38:1247–1253.
Article
9. Schilcher J, Michaëlsson K, Aspenberg P. Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med. 2011; 364:1728–1737.
Article
10. Giusti A, Hamdy NA, Dekkers OM, Ramautar SR, Dijkstra S, Papapoulos SE. Atypical fractures and bisphosphonate therapy: a cohort study of patients with femoral fracture with radiographic adjudication of fracture site and features. Bone. 2011; 48:966–971.
Article
11. Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2014; 29:1–23.
Article
12. Koh JS, Goh SK, Png MA, Ng AC, Howe TS. Distribution of atypical fractures and cortical stress lesions in the femur: implications on pathophysiology. Singapore Med J. 2011; 52:77–80.
13. Yau WP, Chiu KY, Tang WM, Ng TP. Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning. J Orthop Surg (Hong Kong). 2007; 15:32–36.
Article
14. Koch JC. The laws of bone architecture. Am J Anat. 1917; 21:177–298.
Article
15. Oh Y, Wakabayashi Y, Kurosa Y, Fujita K, Okawa A. Potential pathogenic mechanism for stress fractures of the bowed femoral shaft in the elderly: Mechanical analysis by the CT-based finite element method. Injury. 2014; 45:1764–1771.
Article
16. Goh SK, Yang KY, Koh JS, et al. Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution. J Bone Joint Surg Br. 2007; 89:349–353.
17. Meier RP, Perneger TV, Stern R, Rizzoli R, Peter RE. Increasing occurrence of atypical femoral fractures associated with bisphosphonate use. Arch Intern Med. 2012; 172:930–936.
Article
18. Beaudouin-Bazire C, Dalmas N, Bourgeois J, et al. Real frequency of ordinary and atypical sub-trochanteric and diaphyseal fractures in France based on X-rays and medical file analysis. Joint Bone Spine. 2013; 80:201–205.
Article
19. Lo JC, Huang SY, Lee GA, et al. Clinical correlates of atypical femoral fracture. Bone. 2012; 51:181–184.
Article
20. Sasaki S, Miyakoshi N, Hongo M, Kasukawa Y, Shimada Y. Low-energy diaphyseal femoral fractures associated with bisphosphonate use and severe curved femur: a case series. J Bone Miner Metab. 2012; 30:561–567.
Article
21. Park-Wyllie LY, Mamdani MM, Juurlink DN, et al. Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA. 2011; 305:783–789.
Article
22. Feldstein AC, Black D, Perrin N, et al. Incidence and demography of femur fractures with and without atypical features. J Bone Miner Res. 2012; 27:977–986.
Article
23. Dell RM, Adams AL, Greene DF, et al. Incidence of atypical nontraumatic diaphyseal fractures of the femur. J Bone Miner Res. 2012; 27:2544–2550.
Article
Full Text Links
  • HP
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr