Kwan Yiu Hin, Shuy Yao Jie, Shi Claris Jy, Ng Allan Sh
Department of Orthopaedic Surgery, Khoo Teck Puat Hospital 90 Yishun Central, 768828, Singapore.
Int J Burns Trauma. 2022 Jun 15;12(3):73-82. eCollection 2022.
Intramedullary nail fixation is currently the modality of choice in surgical treatment for atypical femoral fractures (AFF). Its uses are limited, however, in severely bowed femurs, narrow medullary canals, or in the presence of thick endosteal callus at the apex of the femoral curve. In these cases, extramedullary plate osteosynthesis is preferred. The consideration when adopting plate osteosynthesis is whether a short or long segment fixation is superior. We hypothesize that a long segment fixation has the potential advantage of protecting the entire length of the femur from future fractures in the adynamic bone. In this series, we present two cases from our institution, with the aims of discussing the benefits and limitations of short versus long segment plate fixation in AFF.
We report two uncommon cases of bisphosphonate-related AFF in two Asian patients with severe femoral curvature, who were treated with extramedullary plate osteosynthesis at our institution. One patient underwent fixation with a short segment plate osteosynthesis, and the other received a long plate osteosynthesis spanning the proximal to distal femur in an attempt to protect the bone from future fractures. Both patients showed a favourable and uncomplicated course post-surgery, with early return to ambulation and radiographic bone union at follow up.
We expect to see an increase in the number of patients with AFF and bowed femurs, especially with the increased usage of bisphosphonates given an ageing Asian population. Surgical treatment with short and long plate osteosynthesis are options with their own advantages and limitations. With the advent of new anatomical plate options, long segment fixation has become more accessible and may be considered in this patient group as it has the potential advantage of protecting the adynamic femur from future fractures. Further studies should be targeted to determine which method of treatment is superior in this particular group of patients.
髓内钉固定术目前是治疗非典型股骨骨折（AFF）的手术首选方式。然而，其应用在严重弯曲的股骨、狭窄的髓腔或股骨曲线顶端存在厚骨内膜骨痂的情况下受到限制。在这些情况下，髓外钢板接骨术更为可取。采用钢板接骨术时需要考虑的是短节段固定还是长节段固定更具优势。我们推测长节段固定具有保护动力不足的股骨全长免受未来骨折影响的潜在优势。在本系列中，我们展示了本院的两例病例，旨在探讨AFF中短节段与长节段钢板固定的利弊。
我们报告了两名亚洲患者中两例罕见的与双膦酸盐相关的AFF，伴有严重股骨弯曲，在本院接受了髓外钢板接骨术治疗。一名患者接受了短节段钢板接骨术固定，另一名患者接受了跨越股骨近端至远端的长钢板接骨术，试图保护骨骼免受未来骨折影响。两名患者术后均呈现良好且无并发症的病程，随访时早期恢复行走且影像学显示骨愈合。
鉴于亚洲人口老龄化，双膦酸盐的使用增加，我们预计AFF和股骨弯曲患者的数量将会增加。短节段和长节段钢板接骨术的手术治疗各有优缺点。随着新型解剖钢板的出现，长节段固定变得更加可行，对于该患者群体可予以考虑，因为它具有保护动力不足的股骨免受未来骨折影响的潜在优势。应开展进一步研究以确定在这一特定患者群体中哪种治疗方法更具优势。
