Abstract
Objective To investigate the efficacy of intramedullary nailing for atypical femoral fractures associated with long-term use of bisphosphonates.Methods A retrospective analysis was conducted of 21 patients with 24 atypical femoral fractures associated with long-term use of bisphosphonates who had been treated with intramedullary nailing from February,2008 to April,2012 in Queen Marry Hospital,Hong Kong.They were 2 men and 19 women,aged from 60 to 95 years (average,74.2 years).There were 10 left fractures,8 right ones and 3 bilateral ones.On average the fractures occurred 58.6 months (range,from 37 to 95 months) after using bisphosphonates.Six fractures had no history of trauma and 18 (in 15 patients) were caused by low-energy injury.There were 11 femoral diaphyseal fractures and 13 subtrochanteric femoral fractures,all AO 32A2.Within 48 hours after admission,the subtrochanteric femoral fractures were treated with long femoral reconstruction nails or long proximal femoral nail antirotation(PFNA) and the femoral diaphyseal fractures with intramedullary nails.Fracture union was observed postoperation and evaluated by the Thoresen system at the last follow-up.Results The average follow-up was 2.0 years (range,from 1.0 to 2.5 years).All the 24 fractures achieved bony union after an average time of 5.1 months (range,from 3 to 8 months).By Thoresen scoring,20 fi actures were excellent,3 good,and one fair,with an excellent to good rate of 95.8％.No operation-related complications occurred.Conclusion Intramedullary nailing is an effective treatment of atypical fractures associated with long-term use of bisphosphonates. Key words: Femoral fractures; Diphosphonates; Fracture fixation, intramedullary; Atypical fractures
Published Version
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