Abstract
Bilateral atypical femoral fractures (AFFs) are relatively rare. In this report, we retrospectively researched clinical features and outcomes of bilateral AFFs treated at our institution. We previously treated 4 patients (8 limbs) with intramedullary nailing for complete AFFs (6 limbs) and incomplete AFFs (2 limbs). The mean age at the first operation was 53.3 years, and all patients were female. Of the 4 patients, two had breast cancer, and another two had systemic lupus erythematosus. Three of them received bisphosphonates, and 2 received denosumab, proton pump inhibitor, or glucocorticoid therapy. Only 2 of 6 cases of incomplete AFFs had prodromal pain before progressing to complete fracture. The mean interval from the first surgery to contralateral fracture or prophylactic surgery was 16 months. Radiographically, complete bone union was achieved in 6 limbs. However, a small gap at the lateral cortex of fracture site remained in 2 limbs. Finally, all of the patients were pain-free and able to walk without a cane. It is absolutely necessary to confirm contralateral femoral conditions; however, prediction of progression to complete fracture based solely on prodromal pain was difficult. Therefore, we should advise patients about the danger of progression to complete AFFs even if they are asymptomatic, and a prophylactic surgery should be performed after obtaining informed consent.
Highlights
According to the Japanese Orthopaedic Association registry report, there were 344 cases of atypical femoral fractures (AFFs) in 2015, 448 in 2016, and 505 in 2017
Saita et al reported that the site of the AFFs along the femoral diaphysis was highly correlated with the deviation between the anatomical axis of the femur and tibia and the mechanical axis of the lower limb [4]
We retrospectively studied the clinical features and outcomes of bilateral AFFs treated in our institution
Summary
According to the Japanese Orthopaedic Association registry report, there were 344 cases of AFFs in 2015, 448 in 2016, and 505 in 2017. In a study involving 142 participants, Dell et al reported that contralateral fractures occurred in 32 patients (22.5%) of the AFF group and were located at the same anatomic location on the contralateral side as on the ipsilateral side [2]. In another study involving 39 participants, Meier et al reported that contralateral fractures occurred in 11 patients (28.2%) in the AFF group. They mentioned that the contralateral fracture was of the same type as the first fracture in all cases [3]. This study describes 4 cases of bilateral AFFs without curvature of the femvoral diaphysis. We retrospectively studied the clinical features and outcomes of bilateral AFFs treated in our institution
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