Roddy Erika, Firoozabadi Reza, Barei David, Beingessner Daphne
University of Washington, Seattle, United States.
Eur J Orthop Surg Traumatol. 2025 Jun 5;35(1):235. doi: 10.1007/s00590-025-04342-0.
Bisphosphonate-associated atypical femur fractures have been reported to have high rates of delayed union and nonunion, as well as high rates of contralateral fracture. There have been limited studies looking at specific factors associated with delayed union or nonunion of atypical fractures. Many studies are limited by small numbers of patients. To date, no studies have examined the effect of reduction technique (closed versus open versus percutaneous) and reduction quality on healing.
This was a multicentered retrospective review of patients greater than 50 years of age with atypical femur fractures treated surgically at level 1 orthopedic trauma center. Patients who were lost to follow-up prior to radiographic union or who were lost to follow-up prior to 6 month follow-up and who had not yet achieved radiographic union were excluded. The primary outcome was union. Secondary outcomes included time to radiographic healing and reoperation.
A total of 148 patients with atypical femoral shaft fractures were identified; 75 patients met inclusion criteria. All were female, with an average age of 75 (standard deviation 8.8). Fifty underwent a closed reduction, 15 underwent open reduction, and 10 had a percutaneous reduction. Reduction quality was excellent in 97% of patients. All patients were treated with an intramedullary implant. Two patients (3%) went on to nonunion, which was diagnosed at an average of nine months postoperatively. Three patients (4%) had delayed union. The median time to union was 3.1 months (IQR 2.9-3.6). In univariate analysis, subtrochanteric fracture location, poor reduction quality, open fracture, and open reduction were each independently associated with increased risk of nonunion or delayed union. The rate of contralateral fracture was only 5% at a median follow-up of 4 years.
DISCUSSION/CONCLUSION: In this cohort of patients with a high rate of well-reduced bisphosphonate-associated femoral shaft fractures, the rate of nonunion and delayed union as well as the median time to radiographic union is significantly lower than has been previously reported. Varus and flexion malreduction, fracture plane gap, open fracture, performing an open reduction, and subtrochanteric fracture location were each independently associated with increased risk of nonunion and delayed union. Finally, there was a low rate (5%) of contralateral fracture.
据报道，双膦酸盐相关的非典型股骨骨折延迟愈合和不愈合率较高，对侧骨折率也较高。针对与非典型骨折延迟愈合或不愈合相关的特定因素的研究有限。许多研究因患者数量少而受到限制。迄今为止，尚无研究探讨复位技术（闭合复位、切开复位与经皮复位）及复位质量对骨折愈合的影响。
这是一项对年龄大于50岁、在一级骨科创伤中心接受手术治疗的非典型股骨骨折患者的多中心回顾性研究。在影像学检查显示骨折愈合前失访的患者，或在6个月随访前失访且尚未达到影像学骨折愈合的患者被排除。主要结局指标是骨折愈合。次要结局指标包括影像学愈合时间和再次手术情况。
共确定148例非典型股骨干骨折患者；75例符合纳入标准。所有患者均为女性，平均年龄75岁（标准差8.8）。50例行闭合复位，15例行切开复位，10例行经皮复位。97%患者复位质量优良。所有患者均接受髓内植入物治疗。2例患者（3%）出现骨折不愈合，平均在术后9个月确诊。3例患者（4%）出现延迟愈合。骨折愈合的中位时间为3.1个月（四分位间距2.9 - 3.6个月）。单因素分析显示，转子下骨折部位、复位质量差、开放性骨折及切开复位均与骨折不愈合或延迟愈合风险增加独立相关。中位随访4年时，对侧骨折率仅为5%。
讨论/结论：在这组双膦酸盐相关股骨干骨折复位良好率较高的患者中，骨折不愈合和延迟愈合率以及影像学骨折愈合的中位时间均显著低于先前报道。内翻和屈曲畸形复位、骨折平面间隙、开放性骨折、进行切开复位以及转子下骨折部位均与骨折不愈合和延迟愈合风险增加独立相关。最后，对侧骨折率较低（5%）。
