Diagnosis and management of atypical femoral fractures: clinical efficacy in 11 cases

Abstract

To evaluate the clinical efficacy of intramedullary nail fixation in atypical femoral fractures and explore the management approach. From January 2010 to December 2014, a total of 116 patients over 60 years old with femoral intertrochanteric fractures or femoral shaft fractures were treated in Department of Orthopaedics and Traumatology. Among the patients, 11 with atypical femoral fractures, aged from 62 to 82 ( 69.3±5.6) years old, received surgical treatments. There were 2 males (18.2%) and 9 females (81.8%). 5 patients (45.5%) had the prodromal symptom of thigh pain. 9 patients (81.8%) had the history of long-term use of bisphosphonates with the duration of 3 to 9 (5.3±2.1) years. All the fractures received close reduction and antegrade intramedullary nail fixation. The Thoresen score and EuroQol 5 dimensions scores (EQ-5D) were applied to evaluate the extremity function and life quality after surgery. All the operations were performed successfully. At least 1 years follow-up was accomplished with the follow-up period of 1 to 4 (1.8±0.9) years. There were 8 (72.7%) excellent, 2 (18.2%) good, 1 (9.1%) fair according to the Thoresen score with total excellent to good rate up to 90.9% at the last follow-up. The EQ-5D scores showed the life quality was similar with that before injury (P>0.05). Fracture healing was achieved in all 11 cases with time from 3 to 8 (5.7±1.6) month. There was no case complicated with infection, nonunion or implant failure during the follow-up period. No contralateral atypical femoral fracture was observed. Atypical femoral fractures are uncommon in the clinical practice. Accurate diagnosis and appropriate management approach are the keys of satisfactory outcomes.