Bisphosphonate-related atypical femoral fractures: A novel strategy to improve patient outcomes

• Published in: Journal of orthopaedics, trauma and rehabilitation trauma and rehabilitation, 2020-12, Vol.27 (2), p.192-197
• Main Authors: Sahemey, Rajpreet, Nikolaides, AP, Bhattacharya, S, Simons, A, Makrides, P
• Format: Article
• Language: English
• ISSN: 2210-4917; 2210-4925
• DOI: 10.1177/2210491720952444

Background: Atypical femoral fracture (AFF) is a serious adverse event associated with bisphosphonate therapy and prone to complications and delayed union. We propose a technique and management strategy to maximise bone healing and outcomes. Methods: We report on a cohort of patients with AFF using our novel technique of preparing the intramedullary canal and rigid fixation with cephalomedullary nailing. Patients were admitted under a multidisciplinary team with rehabilitation goals of early mobilisation and teriparatide initiation. Clinical and radiographic data were retrospectively reviewed. Results: Twenty-eight AFFs were treated with a mean follow-up of 58.5 weeks and a mean age of 75.2 years old. All cases achieved radiological union by a mean of 6 months and post-operative thigh pain experienced up to 8.7 weeks. No cases underwent revision or experienced intraoperative complication. Conclusion: Our surgical technique and multidisciplinary management are reproducible with excellent results in patients with this rare yet challenging injury.