Clinical features of atypical femur fracture

OBJECTIVES: We aim to elucidate the clinical outcomes of bisphosphonate-associated atypical femoral fracture and the clinical results depending on the bisphosphonate therapy period. METHODS: Twenty cases involving 15 patients who had been diagnosed with atypical femoral facture between 2004 and 2014 and who had been followed up for at least 12 months were retrospectively analyzed. The control group was composed of 15 typical femoral facture patients. We used plain radiography and physical examinations to determine the period of time required for fracture healing as well as complication occurrence. We investigated the bisphosphonate administration status and duration and the names of its components, bilateral fracture occurrence status, the period of time required for bone union, and reoperation or bone graft status due to nonunion. RESULTS: Revision surgery involving a bone graft was performed due to nonunion in 1 out of 15 cases. Except in one revision case, the duration of the union was 11.9 months on average in 14 cases of atypical fracture patients, and 4.3 months on average in the control group. This difference was statistically significant (p 0.05). CONCLUSIONS: Atypical femoral fractures required more time for bone union than typical ones and prolonged bisphosphonate administration led to a longer period of time required for bone union.

Clinical Results of Internal Fixation of Subcapital Femoral Neck Fractures

BACKGROUND: Subcapital femoral neck is known to cause many complications, such as avascular necrosis (AVN) of the femoral head or nonunion, compared with other femoral neck fractures. The purpose of this study was to analyze the incidence of AVN and fixation failures in patients treated with internal fixation using cannulated screws for the subcapital femoral neck fractures. METHODS: This study targeted a total of 84 cases of subcapital femoral neck fractures that underwent internal fixation using cannulated screws. The average follow-up time after surgery was 36.8 months (range, 24 to 148 months). RESULTS: Nine hips (10.7%) showing AVN of the femoral head and 6 hips (7.1%) showing fixation failures were observed. The factors affecting the incidence of AVN of the femoral head after sustaining fractures correlated well with fracture types in the Garden classification (p = 0.030). The factors affecting fixation failure were the degree of reduction (p = 0.001) measured by the Garden alignment index and firm fixation (p = 0.009) assessed using the technique of 3-point fixation through the inferomedial cortical bone of the femoral neck. CONCLUSIONS: The complication rates for subcapital femoral neck fractures were lower than those previously reported; hence, internal fixation could be a primary treatment option for these fractures.