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Healing delayed but generally reliable after bisphosphonate-associated complete
femur fractures treated with IM nails
#MMPMID23604648
Egol KA
; Park JH
; Rosenberg ZS
; Peck V
; Tejwani NC
Clin Orthop Relat Res
2014[Sep]; 472
(9
): 2728-34
PMID23604648
show ga
BACKGROUND: Bisphosphonate therapy for osteoporosis has been associated with
atypical femoral fractures. To date, there have been few reports in the
literature regarding the preoperative and postoperative courses of patients who
have sustained bisphosphonate-associated complete atypical femur fractures.
OBJECTIVES/PURPOSES: The purposes of this study were to (1) characterize the
preoperative course of patients who eventually presented with
bisphosphonate-associated complete atypical femur fractures (duration of
bisphosphonate treatment, pain history, risk of converting a nondisplaced
fracture to a complete fracture); (2) evaluate the percentage of patients who
achieved radiographic union of those fractures after treatment; and (3) determine
the patients' recovery of function using the Short Musculoskeletal Functional
Assessment. METHODS: Thirty-three patients with 41 atypical, low-energy femur
fractures associated with ? 5 years of bisphosphonate use were treated with
intramedullary nailing between 2004 and 2011 at one center. The main outcome
measurements were Short Musculoskeletal Functional Assessment for function and
radiographic evaluation for fracture healing. Patients had been treated with
bisphosphonates for an average of 8.8 years (range, 5-20 years) before
presentation. RESULTS: Patients reported a mean of 6 months of pain before
presentation (range, 1-8 months). Sixty-six percent of patients with surgically
treated complete fractures became pain-free and 98% were radiographically healed
by 12 months. Sixty-four percent of patients who underwent intramedullary nailing
reported a functional return to baseline within 1 year. Patients who reported
major functional limitations at latest followup listed pain and apprehension as
the major causes of their limitation. CONCLUSIONS: Patients with surgically
treated bisphosphonate-associated complete femur fractures achieved generally
reliable although delayed fracture healing if malaligned, and nearly two-thirds
of patients returned to self-reported baseline function within 1 year. LEVEL OF
EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete
description of levels of evidence.
|*Bone Nails
[MESH]
|Aged
[MESH]
|Aged, 80 and over
[MESH]
|Bone Density Conservation Agents/adverse effects/therapeutic use
[MESH]
|Diphosphonates/*adverse effects/therapeutic use
[MESH]
free
free
free
