From the Harborview Medical Center, Seattle, WA (Dr. Githens), the Penn State Deparment Orthopaedic Surgery, Pennsylvania State University, State College, PA (Dr. Garner), and the Harborview Medical Center, University of Washington, Seattle, WA (Dr. Firoozabadi).
J Am Acad Orthop Surg. 2018 Dec 15;26(24):864-871. doi: 10.5435/JAAOS-D-16-00717.
Atypical femur fractures associated with long-term bisphosphonate use can be challenging injuries to manage. Not only do they have a prolonged healing time and increased rate of nonunion as compared to typical femur fractures, intraoperative complications are not infrequent and can be catastrophic. Given the pathologic nature of these fractures, a multidisciplinary approach to the patient's care is necessary. Treatment begins with medical optimization and careful surgical planning. Radiographic characteristics of the fracture and femoral osteology dictate reduction strategy, adjunctive surgical techniques, and implant choice. Intraoperative complications including malreduction, iatrogenic fracture, and fracture propagation can be avoided with thoughtful planning. The purpose of this article is to discuss the technical aspects of surgical management of atypical femur fractures. We also discuss management of intraoperative complications and treatment failure. Finally, we provide an update on recommendations for postoperative medical treatment and management of the contralateral femur.
与长期使用双膦酸盐相关的非典型股骨骨折是一种具有挑战性的损伤，难以处理。与典型的股骨骨折相比，它们不仅愈合时间延长，且不愈合的发生率更高，术中并发症也不少见，甚至可能是灾难性的。鉴于这些骨折的病理性，需要对患者进行多学科治疗。治疗始于医疗优化和仔细的手术计划。骨折和股骨干骺端的影像学特征决定了复位策略、辅助手术技术和植入物的选择。通过周密的计划，可以避免术中并发症，如复位不良、医源性骨折和骨折扩展。本文的目的是讨论非典型股骨骨折的手术治疗的技术方面。我们还讨论了术中并发症和治疗失败的处理。最后，我们提供了关于术后药物治疗和对侧股骨处理的建议的最新信息。
