Hindawi Advances in Orthopedics Volume 2018, Article ID 1068053, 5 pages https://doi.org/10.1155/2018/1068053
Research Article Comparison of Atypical and Osteoporotic Femoral Shaft Fractures in the Elderly: A Multicenter Study Takanori Miura ,1 Hiroaki Kijima ,2 Noriyuki Ishikawa,3 Toshihito Ebina,1 Takayuki Tani ,1 Shuichi Chida,1 Tetsuya Suzuki,3 Satoshi Yumto,3 Hiroshi Tazawa,3 Naohisa Miyakoshi ,2 and Yoichi Shimada2 1
Department of Orthopedic Surgery, Kakunodate General Hospital, 3-Iwase Kakunodatemachi, Semboku, Akita 014-0394, Japan Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan 3 Department of Orthopedic Surgery, Akita Red Cross Hospital, Kamikitate Saruta, Aza-Naeshirosawa 222-1, Akita 010-1406, Japan 2
Correspondence should be addressed to Takanori Miura;
[email protected] Received 6 December 2017; Revised 12 March 2018; Accepted 2 April 2018; Published 16 May 2018 Academic Editor: Hiroshi Hashizume Copyright Β© 2018 Takanori Miura et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. In atypical femoral fractures, owing to the high rates of complications and delayed healing that accompany the plate fixation, the most favorable treatment is intramedullary nailing. Although there is insufficient evidence, plate fixation is chosen due to anterolateral bowing of the femur. This study compared the bone healing time and rates of complications in atypical femoral shaft fractures and osteoporotic femoral shaft fractures. Methods. We searched the medical records of 3 institutions in Japan for patients with femoral shaft fractures who visited between 1 January 2010 and 31 December 2015. We identified 65 patients and excluded 37 among these due to high-energy injuries or being younger than 65 years. Among the remaining patients, we identified 17 and 11 women with atypical (AFF group) and osteoporotic femoral shaft fractures (OP group), respectively. Results. In surgical method, there were differences in intramedullary nailing (94.1% versus 27.2%) (π < 0.01). The mean bone healing time was 11.1 months versus 6.7 months in 2 groups (π < 0.01). Iatrogenic femoral fractures during intramedullary nail insertion were observed in both groups, and reoperation was only seen in atypical femoral fractures treated with a plate fixation, but there was no difference in the rate of complications (23.5% versus 9.1%). Conclusions. In the atypical femoral fracture group, intramedullary nailing was more chosen, but the bone healing time was delayed and plate fixation cases needed reoperation. There was no significant difference in the rate of complications between the 2 groups.
1. Introduction Atypical femoral fracture (AFF) is a fracture that occurs at the femoral subtrochanteric or shaft region. The occurrence of this type of fracture is associated with the long-term use of bisphosphonates (BPs) and bowed femoral shaft stress fractures [1β4]. It is a common conception that atypical femoral shaft fractures heal poorly [1, 5], but there have been few reports comparing patients with AFF and the control group with respect to bone healing times [5]. Among the treatment options, intramedullary nail fixation is most favorable. But in some cases with a high degree of lateral femoral bowing, it is difficult to insert the intramedullary nail, and there are consequently high rates of intraoperative fractures and implant failure during the procedure in patients
with AFF [6, 7]. However, the sample size available for the examination of AFF in a single institution is limited. The present multicenter study aimed to compare the bone healing time and rates of complications in patients with atypical femoral shaft fractures and those with osteoporotic femoral shaft fractures.
2. Materials and Methods 2.1. Inclusion Criteria. To identify patients with AFF of the femoral shaft and osteoporotic femoral shaft fractures, we reviewed digitized radiographs of all patients, from 3 institutions, who had sustained fractures of the femoral shaft and received acute treatment for them between 1 January 2010
2
Advances in Orthopedics Table 1: Patient characteristics and treatments.
Parameter Male : Female Age (years) Antiresorptive therapy (%) Surgery (%) Intramedullary nail (%) Fixation with plate (%) Replacement arthroplasty (%) Conservative treatment (%) Teriparatide treatment (%) Postoperative LIPUS treatment (%)
AFF (π = 17)
OP (π = 11)
π
Test
0 : 17 80.7 (77β88) 88.2 100 94.1 5.9 0 0 41.2 23.5
0 : 11 81.0 (65β96) 18.2 81.8 27.2 36.3 18.2 18.2 18.2 9.1
β
β
0.67
MannβWhitney π test
