Rajput Irfan Muhammad, Kumar Jagdesh, Siddiqui Adeel A, Jamil Muhammad, Soughat Muhammad, Ahmed Malik W
Orthopaedic Surgery, Dow University of Health Sciences, Karachi, PAK.
Orthopaedics, Dow University of Health Sciences, Karachi, PAK.
Cureus. 2019 May 17;11(5):e4690. doi: 10.7759/cureus.4690.
Objective To evaluate the outcomes of the surgical fixation of atypical femoral fractures in bisphosphonate-treated patients with an intramedullary device. Materials and methods This multicentric study was carried out at the department of orthopedics, Dr. Ruth Phau Civil Hospital and Medicare Hospital, Karachi, Pakistan, between 2013 and 2018. In this retrospective observational study, we reviewed 10 bisphosphonate-treated patients, fixed surgically with an intramedullary nail after presenting with radiologically characteristic atypical femur fractures identified according to the American Society for Bone and Mineral Research criteria. We excluded patients with fractures sustained by high-energy trauma, road traffic accidents, fall from a height, and those associated with underlying malignancy. Results A total of 11 atypical femoral fractures in 10 patients were included, all of whom were females with a mean age of 68.6 (range 57-82) years. Out of 11 fractures, 81.8% (n=9) were located in the subtrochanteric region and two were located in the femoral shaft. The mean bisphosphonate use was 58.3 months. All patients were treated with intramedullary devices; an intramedullary interlocking nail in two cases and proximal femoral nail antirotation in nine cases. The mean follow-up duration was 12 months. All fractures were united in an average time of 9.9 months (range 6 - 16 months). Implant failure and/or nonunion were not observed, whereas delayed union was noted in five patients. Conclusion Intramedullary fixation is a reliable method for the treatment of atypical femur fractures in bisphosphonate-treated patients owing to its intramedullary placement. These devices act as an internal splint and can provide much more axial stability, reducing the risk of implant fatigue failure due to a delay in fracture healing from prolonged bisphosphonate use.
目的 评估使用髓内装置手术固定双膦酸盐治疗患者非典型股骨骨折的疗效。材料与方法 本多中心研究于2013年至2018年在巴基斯坦卡拉奇的鲁思·保乌市立医院和医疗保险医院骨科进行。在这项回顾性观察研究中，我们回顾了10例双膦酸盐治疗的患者，这些患者在出现根据美国骨与矿物质研究学会标准确定的具有放射学特征的非典型股骨骨折后，接受了髓内钉手术固定。我们排除了因高能创伤、道路交通事故、高处坠落导致骨折的患者，以及与潜在恶性肿瘤相关的骨折患者。结果 共纳入10例患者的11例非典型股骨骨折，均为女性，平均年龄68.6岁（范围57 - 82岁）。11例骨折中，81.8%（n = 9）位于转子下区域，2例位于股骨干。双膦酸盐的平均使用时间为58.3个月。所有患者均接受髓内装置治疗；2例使用髓内交锁钉，9例使用股骨近端抗旋髓内钉。平均随访时间为12个月。所有骨折平均在9.9个月（范围6 - 16个月）内愈合。未观察到植入物失败和/或骨不连，而5例患者出现延迟愈合。结论 髓内固定是治疗双膦酸盐治疗患者非典型股骨骨折的可靠方法，因其髓内放置方式。这些装置起到内部夹板的作用，能提供更强的轴向稳定性，降低因长期使用双膦酸盐导致骨折愈合延迟而引起植入物疲劳失败的风险。
