MINNEAPOLIS – Intramedullary nailing is a successful treatment for patients with bisphosphonate-associated complete femur fractures and displays a low rate of complications and high return to baseline function at 1 year, according to a recent presentation.
However, investigators warned of a significant risk of progression when conservatively treating patients with incomplete fractures.
“Our findings suggest that atypical femoral fractures are well treated with cephalomedullary nail,” Kenneth A. Egol, MD, said during his presentation at the Orthopaedic Trauma Association Annual Meeting 2012. “They take twice as long as the typical femur fractures to heal. Two out of three patients are completely pain-free at follow-up. There was a 15% risk of an incomplete fracture. These results give physicians information to give patients who sustain these injuries.”
Kenneth A. Egol
Egol and colleagues studied 68 patients who sustained 101 atypical femoral fractures associated with bisphosphonate use that were treated at one institution during a 7-year period. Patients with incomplete or nondisplaced fractures were initially treated nonoperatively, which included the discontinuation of bisphosphonates and the addition of vitamin D and/or teriparatide (Forteo, Eli Lily) in selected cases, protected weight-bearing with the use of bone stimulators or a combination of these methods. Patients with displaced complete fractures underwent immediate surgery, Egol said. Healing was determined clinically by the treating physician and radiographically by an independent radiologist. Patients were assessed at a mean of 30 months after injury.
The final study cohort included 35 patients with 44 complete displaced fractures and eight patients with eight incomplete fractures. The patients had an average age of 69 years and had an average 8.5 years of bisphosphonate use.
In the surgically treated group, the investigators found a union rate of 98% at 12 months with 7.8 months mean time to union. In addition, 67 patients in the group were pain-free at latest follow-up and 65% reported return to full baseline function. Egol noted that the one nonunion was due to a technical error. The case was successfully treated with a compression plate and healed 3 months after revision.
“Of interest are the eight patients with eight fractures in the incomplete group who progressed to complete displaced fractures for a 15% rate,” Egol said.
Egol KA, Park JH, Rosenberg ZS, et al. Clinical and functional outcomes in patients who sustained bisphosphonate-associated complete femur fractures. Paper #71. Presented at the Orthopaedic Trauma Association Annual Meeting 2012. Oct. 3-6. Minneapolis.
Disclosure: Egol receives royalties from Exactech Inc., has stock or stock options in Johnson & Johnson and receives research support from Stryker.