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Fu G, Zhong G, Yang Z, Cheng S, Ma L, Zhang Y. Two Cannulated Screws Provide Sufficient Biomechanical Strength for Prophylactic Fixation in Adult Patients With an Aggressive Benign Femoral Neck Lesion. Front Bioeng Biotechnol 2022; 10:891338. [PMID: 35875489 PMCID: PMC9300906 DOI: 10.3389/fbioe.2022.891338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/27/2022] [Indexed: 01/14/2023] Open
Abstract
Background: Two cannulated screws were proposed for prophylactic fixation in adult patients with an aggressive benign femoral neck lesion in recent literature. However, the biomechanical properties of this intervention have not yet been investigated.Methods: After the evaluation of the heterogeneity of bone mineral density and geometry via quantitative computed tomography, 24 embalmed adult human cadaver femurs were randomized into the control, inferior half of the anterior cortical (25%) bone defect, entire anterior cortical (50%) bone defect, and the 50% bone defect and two cannulated screw group. Biomechanical analysis was conducted to compare the stiffness and failure load among the four groups when mimicking a one-legged stance. A CT-based finite element analysis (FEA) was performed to mimic the cortical and cancellous bone defect and the implantation of two cannulated screws of the four groups. Measurements of the maximal displacement and von Mises stress were conducted with the longitudinal load force and boundary conditions being established for a one-leg-standing status.Results: We noted a significant improvement in the failure load after the insertion of two 6.5 mm cannulated screws in femurs with 50% bone defect (+95%, p = 0.048), and no significant difference was found between the screw group and the intact femur. Similar trends were also found in the measurements of stiffness (+23%, p > 0.05) via biomechanical testing and the von Mises stresses (−71%, p = 0.043) by FEA when comparing the screw group and the 50% bone defect group.Conclusion: Our findings suggest that two cannulated screws provided sufficient biomechanical strength for prophylactic fixation in adult patients with an aggressive benign femoral neck lesion even when the entire anterior cortical bone is involved.
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Affiliation(s)
- Guangtao Fu
- Department of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guoqing Zhong
- Department of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical Colleges, Shantou, China
| | - Zehong Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shi Cheng
- Department of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Limin Ma
- Department of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Limin Ma, ; Yu Zhang,
| | - Yu Zhang
- Department of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Limin Ma, ; Yu Zhang,
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Endo D, Saiki K, Yoneda M, Ishida H, Ogami-Takamura K, Sakai R, Murai K, Imamura T, Naito Y, Wakebe T, Tsurumoto T. Application of Methods for a Morphological Analysis of the Femoral Diaphysis Based on Clinical CT Images to Prehistoric Human Bone: Comparison of Modern Japanese and Jomon Populations from Hegi Cave, Oita, Japan. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2069063. [PMID: 35711519 PMCID: PMC9197615 DOI: 10.1155/2022/2069063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 11/18/2022]
Abstract
A morphological analysis of ancient human bones is essential for understanding life history, medical history, and genetic characteristics. In addition to external measurements, a three-dimensional structural analysis using CT will provide more detailed information. The present study examined adult male human skeletons excavated from Hegi cave, Nakatsu city, Oita Prefecture. CT images were taken from the femurs of adult males (Initial/Early Jomon Period (n = 10) and Late Jomon Period (n = 5)). Cross-sectional images of the diaphysis from below the lesser trochanter to above the adductor tubercle were obtained using the method established by Imamura et al. (2019) and Imamura et al. (2021). Using Excel formulas and macros, the area of cortical bone, thickness, and degree of curvature were quantitatively analyzed. The results were compared with data on modern Japanese. The maximum thickness of cortical bone in the diaphysis and the degree of the anterior curvature were significantly greater in Late Jomon humans than in the other groups. In contrast to modern humans, the majority of Jomon femurs showed the S-shaped curvature with the medial side at the top position and the lateral side at the lower position. The present results demonstrate that Late Jomon humans had a wider range of activity than the other groups and also provide insights into diseases in the hip and knee joints of Jomon humans.
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Affiliation(s)
- Daisuke Endo
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki 852-8523, Japan
| | - Kazunobu Saiki
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki 852-8523, Japan
| | - Minoru Yoneda
- The University Museum, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hajime Ishida
- Department of Human Biology and Anatomy, Graduate School of Medicine, University of the Ryukyus, Senbaru 1, Nishihara, Okinawa 903-0213, Japan
| | - Keiko Ogami-Takamura
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki 852-8523, Japan
- Center of Cadaver Surgical Training, School of Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki 852-8523, Japan
- Department of Anesthesiology and Intensive Care Medicine, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Nagasaki 852-8501, Japan
| | - Rina Sakai
- School of Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki 852-8523, Japan
| | - Kiyohito Murai
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki 852-8523, Japan
| | - Takeshi Imamura
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki 852-8523, Japan
| | - Yoshiatsu Naito
- Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki 852-8523, Japan
| | - Tetsuaki Wakebe
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki 852-8523, Japan
- Nagasaki Medical College, 36-59 Atago, Nagasaki, Nagasaki 850-0822, Japan
| | - Toshiyuki Tsurumoto
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki 852-8523, Japan
- Center of Cadaver Surgical Training, School of Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki 852-8523, Japan
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3
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Griffin LV, Warner E, Palnitkar S, Qiu S, Honasoge M, Griffin SG, Divine G, Rao SD. Bone Nanomechanical Properties and Relationship to Bone Turnover and Architecture in Patients With Atypical Femur Fractures: A Prospective Nested Case-Control Study. JBMR Plus 2021; 5:e10523. [PMID: 34532612 PMCID: PMC8441274 DOI: 10.1002/jbm4.10523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/18/2021] [Accepted: 06/02/2021] [Indexed: 11/20/2022] Open
Abstract
Atypical femur fractures (AFFs) are well‐established serious complication of long‐term bisphosphonate and denosumab therapy in patients with osteopenia or osteoporosis. To elucidate underlying mechanism(s) for the development of AFF, we performed a nested case‐control study to investigate bone tissue nanomechanical properties and prevailing bone microstructure and tissue‐level remodeling status as assessed by bone histomorphometry. We hypothesized that there would be differences in nanomechanical properties between patients with and without AFF and that bone microstructure and remodeling would be related to nanomechanical properties. Thirty‐two full‐thickness transiliac bone biopsies were obtained from age‐ and sex‐matched patients on long‐term bisphosphonate therapy with (n = 16) and without an AFF (n = 16). Standard histomorphometric measurements were made in each sample on three different bone envelopes (cancellous, intracortical, and endosteal). Iliac bone wall thickness was significantly lower on all three bone surfaces in patients with AFF than in those without AFF. Surface‐based bone formation rate was suppressed similarly in both groups in comparison to healthy premenopausal and postmenopausal women, with no significant difference between the two groups. Nanoindentation was used to assess material properties of cortical and cancellous bone separately. Elastic modulus was higher in cortical than in cancellous bone in patients with AFF as well as compared to the elastic modulus of cortical bone from non‐AFF patients. However, the elastic modulus of the cancellous bone was not different between AFF and non‐AFF groups or between cortical and cancellous bone of non‐AFF patients. Resistance to plastic deformation was decreased in cortical bone in both AFF and non‐AFF groups compared to cancellous bone, but to a greater extent in AFF patients. We conclude that long‐term bisphosphonate therapy is associated with prolonged suppression of bone turnover resulting in altered cortical remodeling and tissue nanomechanical properties leading to AFF. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Lanny V Griffin
- California Polytechnic State University (Cal Poly) San Luis Obispo CA USA
| | - Elizabeth Warner
- Bone & Mineral Research Laboratory Henry Ford Health System/Wayne State University Integrative Biosciences (IBio) Research Facility Detroit MI USA
| | - Saroj Palnitkar
- Bone & Mineral Research Laboratory Henry Ford Health System/Wayne State University Integrative Biosciences (IBio) Research Facility Detroit MI USA
| | - Shijing Qiu
- Bone & Mineral Research Laboratory Henry Ford Health System/Wayne State University Integrative Biosciences (IBio) Research Facility Detroit MI USA
| | - Mahalakshmi Honasoge
- Division of Endocrinology, Diabetes, and Bone & Mineral Disorders Henry Ford Health System Detroit MI USA
| | - Shawna G Griffin
- California Polytechnic State University (Cal Poly) San Luis Obispo CA USA
| | - George Divine
- Department of Public Health Sciences Henry Ford Health System Detroit MI USA
| | - Sudhaker D Rao
- Bone & Mineral Research Laboratory Henry Ford Health System/Wayne State University Integrative Biosciences (IBio) Research Facility Detroit MI USA.,Division of Endocrinology, Diabetes, and Bone & Mineral Disorders Henry Ford Health System Detroit MI USA
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Crouch G, Dhanekula ND, Byth K, Burn E, Lau SL, Nairn L, Nery L, Doyle J, Graham E, Ellis A, Clifton-Bligh RJ, Girgis CM. The Sydney AFF Score: A Simple Tool to Distinguish Females Presenting With Atypical Femur Fractures Versus Typical Femur Fractures. J Bone Miner Res 2021; 36:910-920. [PMID: 33528853 DOI: 10.1002/jbmr.4255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 01/21/2023]
Abstract
Atypical femur fractures (AFF) are a rare but serious complication of long-term bisphosphonate use. Although clearly defined by ASBMR criteria, a proportion of patients with AFFs may go unrecognized and the use of qualitative fracture criteria may lead to uncertainty in AFF diagnosis, with significant therapeutic implications. A score that rapidly and accurately identifies AFFs among subtrochanteric femur fractures using quantitative, measurable parameters is needed. In a retrospective cohort of 110 female patients presenting with AFFs or typical femur fractures (TFFs), multiple logistic regression and decision tree analysis were used to develop the Sydney AFF score. This score, based on demographic and femoral geometry variables, uses three dichotomized independent predictors and adds one point for each: (age ≤80 years) + (femoral neck width <37 mm) + (lateral cortical width at lesser trochanter ≥5 mm), (score, 0 to 3). In an independent validation set of 53 female patients at a different centre in Sydney, a score ≥2 demonstrated 73.3% sensitivity and 69.6% specificity for AFF (area under the receiver-operating characteristic curve [AUC] 0.775, SE 0.063) and remained independently associated with AFF after adjustment for bisphosphonate use. The Sydney AFF score provides a quantitative means of flagging female patients with atraumatic femur fractures who have sustained an AFF as opposed to a TFF. This distinction has clear management implications and may augment current ASBMR diagnostic criteria. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Gareth Crouch
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nitesh D Dhanekula
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Orthopaedic Surgery, Westmead Hospital, Westmead, NSW, Australia
| | - Karen Byth
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Western Sydney Local Health District (WSLHD) Research and Education Network, Westmead Hospital, Westmead, NSW, Australia
| | - Emma Burn
- Department of Medicine, West Suffolk Hospital, Bury St Edmonds, UK
| | - Sue Lynn Lau
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Endocrinology and Diabetes, Westmead Hospital, Westmead, NSW, Australia
| | - Lillias Nairn
- Department of Physiotherapy, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Liza Nery
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jean Doyle
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Edward Graham
- Department of Orthopaedic Surgery, Westmead Hospital, Westmead, NSW, Australia
| | - Andrew Ellis
- Department of Orthopaedic Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Roderick J Clifton-Bligh
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Endocrinology and Diabetes, Royal North Shore Hospital, St Leonards, NSW, Australia.,Kolling Institute of Medical Research, Sydney, NSW, Australia
| | - Christian M Girgis
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Endocrinology and Diabetes, Westmead Hospital, Westmead, NSW, Australia.,Department of Endocrinology and Diabetes, Royal North Shore Hospital, St Leonards, NSW, Australia.,The Westmead Institute for Medical Research, Westmead, NSW, Australia
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Deligiorgi MV, Trafalis DT. The safety profile of denosumab in oncology beyond the safety of denosumab as an anti-osteoporotic agent: still more to learn. Expert Opin Drug Saf 2020; 20:191-213. [PMID: 33287586 DOI: 10.1080/14740338.2021.1861246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Initially endorsed as an antiosteoporotic agent, denosumab ‒ human monoclonal antibody inhibiting the receptor activator of nuclear factor kappa-B ligand (RANKL)‒ has currently shown an anticancer potential, rationalizing its exploitation in oncology. A prerequisite for leveraging denosumab in oncology is a favorable safety profile. AREAS COVERED The present review provides an overview of the adverse events of denosumab in oncology, with a focus on hypocalcemia, medication-related osteonecrosis of the jaw, atypical femoral fracture(s), post-denosumab vertebral fractures, increased risk of infections, and excess of second primary cancer. Representative studies addressing the safety and efficacy of denosumab compared to bisphosphonates in oncology are summarized. Critical gaps in the literature concerning the safety of denosumab in oncology are highlighted as opposed to plenty of available safety data on denosumab as an antiosteoporotic agent. EXPERT OPINION Despite the generally acceptable safety profile of denosumab in oncology, many issues remain unresolved. Further research is mandatory to counteract current challenges, namely: (i) validation of risk factors for adverse events; (ii) elucidation of the pathophysiology of the adverse events in search of actionable molecular pathways; (iii) illumination of the association of denosumab with increased risk of infections and/or second primary cancer; (iv) establishment of optimal diagnostic, and therapeutic protocols.
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Affiliation(s)
- Maria V Deligiorgi
- Department of Pharmacology - Clinical Pharmacology Unit, National and Kapodistrian University of Athens, Faculty of Medicine , Athens, Greece
| | - Dimitrios T Trafalis
- Department of Pharmacology - Clinical Pharmacology Unit, National and Kapodistrian University of Athens, Faculty of Medicine , Athens, Greece
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6
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Cheung E, Borno HT. The limitations of today’s clinical guidance: Atypical femoral fracture and long-term bone-modifying agents in the oncology setting. J Oncol Pharm Pract 2020; 26:1180-1189. [DOI: 10.1177/1078155220907965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
While bone-modifying agents such as bisphosphonates and denosumab are crucial to preventing skeletal-related events in patients with bone metastases, the optimal duration remains undefined. Extended duration may be associated with adverse effects such as osteonecrosis of the jaw and atypical femoral fracture. Although uncommon, atypical femoral fracture represents a serious consequence of prolonged bone-modifying agent use and are characterized by a prodrome and distinct radiographic findings. The oncology setting encompasses a unique set of atypical femoral fracture risk factors and considerations, with hormonal therapy in early stage disease, bone metastases in the advanced setting, and new targeted agents that may affect bone homeostasis. As outcomes in cancer treatment continue to improve, the questions of risks versus benefits of long-term bone-modifying agents and how to mitigate atypical femoral fracture risk become increasingly pertinent.
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Affiliation(s)
- Edna Cheung
- Department of Clinical Pharmacy and School of Pharmacy, University of California San Francisco, San Francisco, USA
| | - Hala T Borno
- Division of Hematology/Oncology, School of Medicine, University of California San Francisco, San Francisco, USA
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Abstract
Members of the International Skeletal Society compiled a glossary of terms for musculoskeletal radiology. The authors also represent national radiology or pathology societies in Asia, Australia, Europe, and the USA. We provide brief descriptions of musculoskeletal structures, disease processes, and syndromes and address their imaging features. Given the abundance of musculoskeletal disorders and derangements, we chose to omit most terms relating to neoplasm, spine, intervention, and pediatrics. Consensus agreement was obtained from 19 musculoskeletal radiology societies worldwide.
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Lim SJ, Yeo I, Yoon PW, Yoo JJ, Rhyu KH, Han SB, Lee WS, Song JH, Min BW, Park YS. Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study. Osteoporos Int 2018; 29:2427-2435. [PMID: 30039251 DOI: 10.1007/s00198-018-4640-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 07/11/2018] [Indexed: 12/13/2022]
Abstract
UNLABELLED The incidence of atypical femoral fractures (AFFs) was 2.95% among 6644 hip and femoral fractures. Independent risk factors included the use of bisphosphonates (BPs), osteopenia or osteoporosis, rheumatoid arthritis, increased femoral curvatures, and thicker femoral cortices. Patients with AFFs and BP treatment were more likely to have problematic healing than those with typical femoral fractures (TFFs) and no BP treatment. INTRODUCTION To determine the incidence and risk factors of atypical femoral fractures (AFFs), we performed a multicenter case-control study. We also investigated the effects of bisphosphonates (BPs) on AFF healing. METHODS We retrospectively reviewed the medical records and radiographs of 6644 hip and femoral fractures of patients from eight tertiary referral hospitals. All the radiographs were reviewed to distinguish AFFs from TFFs. Univariate and multivariate logistic regression analyses were performed to identify risk factors, and interaction analyses were used to investigate the effects of BPs on fracture healing. RESULTS The incidence of AFFs among 6644 hip and femoral fractures was 2.95% (90 subtrochanter and 106 femoral shaft fractures). All patients were females with a mean age of 72 years, and 75.5% were exposed to BPs for an average duration of 5.2 years (range, 1-17 years). The use of BPs was significantly associated with AFFs (p < 0.001, odds ratio = 25.65; 95% confidence interval = 10.74-61.28). Other independent risk factors for AFFs included osteopenia or osteoporosis, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex at the shaft level. Interaction analyses showed that patients with AFFs using BPs had a significantly higher risk of problematic fracture healing than those with TFFs and no BP treatment. CONCLUSIONS The incidence of AFFs among 6644 hip and femoral fractures was 2.95%. Osteopenia or osteoporosis, use of BPs, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex were independent risk factors for the development of AFFs. Patients with AFFs and BP treatment were more likely to have problematic fracture healing than those with TFFs and no BP treatment.
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MESH Headings
- Aged
- Aged, 80 and over
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/epidemiology
- Arthritis, Rheumatoid/physiopathology
- Bone Density Conservation Agents/adverse effects
- Bone Density Conservation Agents/pharmacology
- Case-Control Studies
- Diphosphonates/adverse effects
- Diphosphonates/pharmacology
- Female
- Femoral Fractures/diagnostic imaging
- Femoral Fractures/epidemiology
- Femoral Fractures/etiology
- Femoral Fractures/physiopathology
- Fracture Healing/drug effects
- Fractures, Spontaneous/diagnostic imaging
- Fractures, Spontaneous/epidemiology
- Fractures, Spontaneous/etiology
- Fractures, Spontaneous/physiopathology
- Hip Fractures/diagnostic imaging
- Hip Fractures/epidemiology
- Hip Fractures/etiology
- Hip Fractures/physiopathology
- Humans
- Incidence
- Middle Aged
- Osteoporosis, Postmenopausal/complications
- Osteoporosis, Postmenopausal/epidemiology
- Osteoporosis, Postmenopausal/physiopathology
- Osteoporotic Fractures/diagnostic imaging
- Osteoporotic Fractures/epidemiology
- Osteoporotic Fractures/etiology
- Osteoporotic Fractures/physiopathology
- Radiography
- Republic of Korea/epidemiology
- Risk Factors
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Affiliation(s)
- S-J Lim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - I Yeo
- Department of Orthopaedic Surgery, Sejong General Hospital, Gyeongi-do, Bucheon-si, South Korea
| | - P-W Yoon
- Department Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - J J Yoo
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - K-H Rhyu
- Department of Orthopaedic Surgery, Kyung Hee Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - S-B Han
- Department of Orthopedics, Korea University Anam Hospital, Korea University College of Medicine, Seongbuk-gu, Seoul, South Korea
| | - W-S Lee
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - J-H Song
- Department of Orthopaedic Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, South Korea
| | - B-W Min
- Department of Orthopaedic Surgery, Dongsan Medical Center, Kyemyung University College of Medicine, Daegu, South Korea
| | - Y-S Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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Abstract
Atypical femoral fractures (AFF) are stress or ‘insufficiency’ fractures, often complicated by the use of bisphosphonates or other bone turnover inhibitors. While these drugs are beneficial for the intact osteoporotic bone, they probably prevent a stress fracture from healing which thus progresses to a complete fracture. Key features of atypical femoral fractures, essential for the diagnosis, are: location in the subtrochanteric region and diaphysis; lack of trauma history and comminution; and a transverse or short oblique configuration. The relative risk of patients developing an atypical femoral fracture when taking bisphosphonates is high; however, the absolute risk of these fractures in patients on bisphosphonates is low, ranging from 3.2 to 50 cases per 100,000 person-years. Treatment strategy in patients with AFF involves: radiograph of the contralateral side (computed tomography and magnetic resonance imaging should also be considered); dietary calcium and vitamin D supplementation should be prescribed following assessment; bisphosphonates or other potent antiresorptive agents should be discontinued; prophylactic surgical treatment of incomplete AFF with cephalomedullary nail, unless pain free; cephalomedullary nailing for surgical fixation of complete fractures; avoidance of gaps in the lateral and anterior cortex; avoidance of varus malreduction.
Cite this article: EFORT Open Rev 2018;3:494-500. DOI: 10.1302/2058-5241.3.170070.
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Affiliation(s)
| | - Hagen Schmal
- Department of Orthopaedics and Traumatology, Odense University Hospital, Denmark
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