Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY 10003, USA.
J Orthop Trauma. 2013 Jun;27(6):331-5. doi: 10.1097/BOT.0b013e31827240ae.
To describe the outcomes for patients treated at a single institution, who sustained incomplete bisphosphonate-induced femoral fractures.
Retrospective review.
University-based academic medical center.
Thirty-one patients with 43 incomplete fractures met the inclusion criteria.
Nonoperative management or surgical intervention for fractures with refractory symptoms or progression of fracture lucency on radiographs.
Radiographic assessments and the Short Musculoskeletal Functional Assessment to gauge functional status.
The cohort was all women with an average age of 69.2 (range: 46-92) years and had been treated with bisphosphonate therapy for an average of 9.1 (range: 5-20) years. The average healing time for all incomplete fractures was 9.4 (range: 1.5-36) months. Forty-nine percent of the fractures (21 of 43 fractures) were ultimately treated with surgery for impending complete fracture or failure of nonsurgical management. Of the incomplete fractures treated with surgery, 81% became pain free and 100% were radiographically healed at a mean of 7.1 (range: 1.5-12) months. In contrast, of the nonoperatively treated incomplete fractures, only 64% were pain free at latest follow-up, with only 18% of fractures demonstrating radiographic evidence of healing at an average of 11 (range: 6-24) months. Standardized dysfunction index from the Short Musculoskeletal Functional Assessment was better (19.7) in the surgical group than in the nonsurgical group (19.7 vs. 25.7, P = 0.0017).
A higher percentage of patients treated surgically became asymptomatic and demonstrated radiographic evidence of healing earlier than those treated nonsurgically. Surgical intervention is effective for relief of symptoms when treating incomplete bisphosphonate-related femur fractures, and patients should be counseled to the potential benefits of prophylactic surgery.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
描述在单一机构接受治疗的不完全双膦酸盐诱导股骨骨折患者的治疗结果。
回顾性研究。
基于大学的学术医疗中心。
31 名患者的 43 处不完全骨折符合纳入标准。
对有难治性症状或放射影像学上骨折透亮区进展的骨折进行非手术或手术治疗。
放射影像学评估和短肌肉骨骼功能评估以评估功能状态。
该队列均为女性，平均年龄 69.2（范围：46-92）岁，接受双膦酸盐治疗的平均时间为 9.1（范围：5-20）年。所有不完全骨折的平均愈合时间为 9.4（范围：1.5-36）个月。49%（43 处骨折中的 21 处）的骨折最终因即将发生完全骨折或非手术治疗失败而接受手术治疗。在接受手术治疗的不完全骨折中，81%的患者疼痛缓解，100%的患者在平均 7.1（范围：1.5-12）个月时放射影像学上愈合。相比之下，在接受非手术治疗的不完全骨折中，只有 64%的患者在末次随访时无疼痛，只有 18%的骨折在平均 11（范围：6-24）个月时显示放射影像学愈合证据。手术组的短肌肉骨骼功能评估标准化功能障碍指数（19.7）优于非手术组（19.7 比 25.7，P = 0.0017）。
与接受非手术治疗的患者相比，接受手术治疗的患者有更高的比例无症状且更早出现放射影像学愈合证据。手术干预治疗不完全双膦酸盐相关性股骨骨折时可有效缓解症状，应向患者提供预防性手术的潜在益处。
治疗性三级。有关证据水平的完整说明，请参见作者指南。
