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Undisturbed local bone formation capacity in patients with atypical femoral fractures: a case series
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
Gavle Central Hospital, Sweden.
2017 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 28, no 8, 2439-2444 p.Article in journal (Refereed) Published
Abstract [en]

We excised the fracture site in 8 patients with incomplete atypical femoral fractures by drilling an 11-mmdiameter hole. New bone formation could be seen in the hole within a normal time frame. Delayed healing of these fractures might be unrelated to an impaired capacity to form bone. Introduction Incomplete atypical femoral fractures (undisplaced cracks) heal slowly or not at all, and often progress to a complete fracture with minimal trauma. The impaired healing has been attributed to an impaired biologic healing capacity related to bisphosphonate use, or, alternatively, to the mechanical environment within the fracture crack. This study aimed to investigate the capacity for bone formation after resection of the fracture site. Methods Between 2008 and 2014, we recruited eight patients with incomplete atypical femoral fractures. All used oral bisphosphonates before the fracture for on average 8 years (range 4 to 15) and complained of thigh pain. The fractures were stabilized with reamed cephalomedullary nails. During surgery, the fracture site in the lateral cortex was resected with a cylindrical drill (diameter 11.5 mm). The cylindrical cortical defect allowed radiographic evaluation of new bone formation, and the patients were followed clinically and radiologically for 24 months (range 15 to 92). Results After 3 months, newly formed bone could be seen in the cortical defects in all patients. After 13-26 months, the previous defects showed continuous cortical bone. At final follow-up, all patients reported full recovery of pre-surgical complaints. No complications occurred and no reoperations were performed. Conclusions New bone formation occurred within a time frame that appears normal for healing of cortical bone defects. This suggests that the capacity to form new bone is intact.

Place, publisher, year, edition, pages
SPRINGER LONDON LTD , 2017. Vol. 28, no 8, 2439-2444 p.
Keyword [en]
Atypical femoral fracture; Bisphosphonates; Fracture healing; Osteoporosis
National Category
Orthopedics
Identifiers
URN: urn:nbn:se:liu:diva-139913DOI: 10.1007/s00198-017-4058-4ISI: 000406275400023PubMedID: 28474166OAI: oai:DiVA.org:liu-139913DiVA: diva2:1135456
Note

Funding Agencies|Swedish Research Council [VR 2012-1878]; Linkping University, Ostergtland County Council; Swedish Society of Medicine

Available from: 2017-08-23 Created: 2017-08-23 Last updated: 2017-09-14Bibliographically approved

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Aspenberg, Per
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Department of Clinical and Experimental MedicineFaculty of Medicine and Health SciencesDivision of Surgery, Orthopedics and OncologyDepartment of Orthopaedics in Linköping
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Osteoporosis International
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