Larsen Morten Schultz, Schmal Hagen
Department of Orthopaedics and Traumatology, Odense University Hospital, Denmark.
EFORT Open Rev. 2018 Sep 12;3(9):494-500. doi: 10.1302/2058-5241.3.170070. eCollection 2018 Sep.
Atypical femoral fractures (AFF) are stress or 'insufficiency' fractures, often complicated by the use of bisphosphonates or other bone turnover inhibitors. While these drugs are beneficial for the intact osteoporotic bone, they probably prevent a stress fracture from healing which thus progresses to a complete fracture.Key features of atypical femoral fractures, essential for the diagnosis, are: location in the subtrochanteric region and diaphysis; lack of trauma history and comminution; and a transverse or short oblique configuration.The relative risk of patients developing an atypical femoral fracture when taking bisphosphonates is high; however, the absolute risk of these fractures in patients on bisphosphonates is low, ranging from 3.2 to 50 cases per 100,000 person-years.Treatment strategy in patients with AFF involves: radiograph of the contralateral side (computed tomography and magnetic resonance imaging should also be considered); dietary calcium and vitamin D supplementation should be prescribed following assessment; bisphosphonates or other potent antiresorptive agents should be discontinued; prophylactic surgical treatment of incomplete AFF with cephalomedullary nail, unless pain free; cephalomedullary nailing for surgical fixation of complete fractures; avoidance of gaps in the lateral and anterior cortex; avoidance of varus malreduction. Cite this article: 2018;3:494-500. DOI: 10.1302/2058-5241.3.170070.
非典型股骨骨折（AFF）是应力性或“不全性”骨折，常因使用双膦酸盐或其他骨转换抑制剂而复杂化。虽然这些药物对完整的骨质疏松性骨有益，但它们可能会阻止应力性骨折愈合，从而发展为完全骨折。非典型股骨骨折的关键特征对诊断至关重要，包括：位于转子下区域和骨干；无创伤史且无粉碎；呈横行或短斜行形态。服用双膦酸盐的患者发生非典型股骨骨折的相对风险较高；然而，服用双膦酸盐的患者发生这些骨折的绝对风险较低，每10万人年为3.2至50例。AFF患者的治疗策略包括：对侧进行X线检查（也应考虑计算机断层扫描和磁共振成像）；评估后应给予饮食补充钙和维生素D；应停用双膦酸盐或其他强效抗吸收剂；除非无痛，否则用髓内钉对不完全性AFF进行预防性手术治疗；用髓内钉对完全骨折进行手术固定；避免外侧和前方皮质出现间隙；避免内翻畸形愈合。引用本文：2018；3：494 - 500。DOI：10.1302/2058 - 5241.3.170070。
