Department of Orthopaedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea.
Geriatric Fracture Center, Keimyung University Dongsan Hospital, Daegu, South Korea.
J Bone Joint Surg Am. 2021 Jan 20;103(2):123-130. doi: 10.2106/JBJS.20.00807.
Atypical femoral fracture (AFF) is associated with high prevalence rates of prodromal symptoms, bilateral involvement, complications, and the need for prophylactic fixation due to a risk of an impending fracture. Although most complete AFF cases have an asymptomatic contralateral femur at the initial presentation, there is lack of clarity on its progression. We evaluated the radiographic progression of asymptomatic contralateral femora in patients with a complete AFF and investigated the characteristics of these patients.
The medical records of 80 consecutive patients who had been treated for a complete AFF were retrospectively evaluated. We excluded 14 patients who had been lost to follow-up, 10 whose contralateral femur initially had been symptomatic and had been treated simultaneously, and 3 whose contralateral femur had previously been treated surgically. The remaining 53 patients were all women with an average age of 71.8 years. The average duration of bisphosphonate (BP) use was 63.6 months, and the mean follow-up duration was 48.9 months. All of the contralateral femora were asymptomatic and were divided into 2 grades according to the initial radiographic findings. We evaluated the prevalence of radiographic progression according to the grades and compared patient characteristics between the progression and non-progression groups.
Radiographic progression was noted in 18 patients (34%) during the follow-up: 3 (12%) of 25 in grade 1 and 15 (53.6%) of 28 in grade 2 (p < 0.001). The mean time to progression for these 18 patients was 25.6 months, which also differed significantly depending on the grade (p = 0.02). Eleven and 9 (61.1% and 25.7%) of the patients received BP postoperatively in the progression and non-progression groups, respectively (p = 0.01).
The prevalence of radiographic progression was relatively high, even though the contralateral femur was initially asymptomatic, and differed significantly according to the initial radiographic grade. The frequency of postoperative BP use was significantly higher in the progression group.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
非典型股骨骨折（AFF）与较高的前驱症状发生率、双侧受累、并发症以及由于即将发生骨折而需要预防性固定相关。尽管大多数完全性 AFF 病例在初次就诊时，对侧股骨无症状，但对其进展情况尚不清楚。我们评估了完全性 AFF 患者无症状对侧股骨的放射学进展情况，并研究了这些患者的特征。
回顾性评估了 80 例连续接受完全性 AFF 治疗的患者的病历。我们排除了 14 例失访患者、10 例对侧股骨最初有症状且同时接受治疗的患者和 3 例对侧股骨先前接受手术治疗的患者。其余 53 例均为女性，平均年龄 71.8 岁。双膦酸盐（BP）使用的平均时间为 63.6 个月，平均随访时间为 48.9 个月。所有对侧股骨均无症状，根据初始影像学表现分为 2 个等级。我们根据等级评估放射学进展的发生率，并比较进展组和非进展组患者的特征。
在随访期间，18 例（34%）患者出现放射学进展：25 例中 1 级的 3 例（12%）和 28 例中 2 级的 15 例（53.6%）（p < 0.001）。这 18 例患者的进展时间平均为 25.6 个月，且根据等级显著不同（p = 0.02）。进展组和非进展组分别有 11 例和 9 例（61.1%和 25.7%）患者术后接受 BP 治疗（p = 0.01）。
即使对侧股骨最初无症状，放射学进展的发生率也相对较高，且根据初始影像学分级有显著差异。进展组术后 BP 使用率显著更高。
预后 III 级。有关证据水平的完整描述，请参见作者说明。
