A Novel Surgical Method for Treating Symptomatic Incomplete Atypical Femoral Fracture using Percutaneous Elastic Intramedullary Nailing

The role of the fracture liaison service in the prevention of atypical femoral fractures

Osteoporosis and fragility fractures (FFs) are considered critical health problems by the World Health Organization (WHO) because of high morbidity, mortality, and healthcare costs. The occurrence of a FF raises the risk of a subsequent fracture (refracture). The hip is the most common site of fragility refracture, and its onset is associated with a further increase in patient's morbidity, mortality, and socioeconomic burden. Therefore, the prevention of refracture is essential. In this context, fracture liaison service (FLS) demonstrated to be able to reduce FF risk and also improve patients' adherence to anti-osteoporotic treatments, particularly for bisphosphonates (BPs). However, long-term and high adherence to BPs may lead to atypical femoral fractures (AFFs). These latter are tensile side stress fractures of the femur, with high rates of complications, including delayed and non-healing. An effective FLS should be able to prevent both FF and AFF. A comprehensive and interdisciplinary approach, through the involvement and education of a dedicated team of healthcare professionals (i.e. orthopedic, geriatrician, primary care physician, rehabilitation team, and bone nurse) for evaluating both FF and AFF risks might be useful to improve the standard of care.

Incomplete Atypical Femoral Fracture With Severe Bowing Treated by Intramedullary Nail and Corrective Osteotomy

We present the case of an 82-year-old female who had difficulty walking due to right thigh pain caused by incomplete atypical femoral fracture (AFF). The femoral bowing was so severe that intramedullary nail insertion was impossible, so we performed a corrective osteotomy of the femur and inserted the intramedullary nail. Postoperatively, the femoral pain disappeared, and bone fusion was achieved at one year and two months postoperatively. In cases of incomplete AFF with very severe femoral bowing, internal fixation with an intramedullary nail combined with corrective osteotomy of the femur is useful.

Bilateral Incomplete Atypical Femur Fractures with Severe Bowing Treated Using Elastic Intramedullary Nails: A Case Report

CASE

A 77-year-old woman with bilateral symptomatic atypical femoral fractures (AFFs) and severe anterolateral bowing due to long-term bisphosphonate administration was treated using stainless elastic intramedullary nails. Weight-bearing pain disappeared immediately after surgery. Radiographs obtained 1 year postoperatively showed fracture healing.

CONCLUSION

Although intramedullary nail insertion has been recommended for symptomatic incomplete AFFs, in cases of severe bowing, rigid nail insertion was often challenging, and the complication rates were higher than those with mild bowing. The advantage of our method is easy insertion, suggesting effective treatment.