Evaluation and management of atypical femoral fractures: an update of current knowledge.
Eur J Orthop Surg Traumatol
; 31(5): 825-840, 2021 Jul.
Article
em En
| MEDLINE
| ID: mdl-33590316
ABSTRACT
Atypical femoral fractures are often attributed to the use of anti-resorptive medications such as bisphosphonates (BP). Whilst they have proven effects on fragility fracture prevention, clinical and laboratory evidence is evolving linking BP-related suppression of bone remodelling to the development of atypical stress-related sub-trochanteric fractures (Shane et al. in JBMR 291-23, 2014; Odvina et al. in JCEM 901294-301, 2005; Durchschlag et al. in JBMR 21(10)1581-1590, 2006; Donnelly et al. in JBMR 27672-678, 2012; Mashiba et al. in Bone 28(5)524-531, 2001; Dell et al. in JBMR 27(12)2544-2550, 2012; Black et al. in Lancet 3481535-1541, 1996; Black et al. in NEJM 3561809-1822, 2007; Black et al. in JAMA 2962927-2938, 2006; Schwartz et al. in JBMR 25976-82, 2010). Injuries may present asymptomatically or with prodromal thigh pain and most can be successfully managed with cephalomedullary nailing and discontinuation of BP therapy. Such injuries exhibit a prolonged time to fracture union with high rates of non-union and metal-work failure when compared to typical subtrochanteric osteoporotic femoral fractures. Despite emerging literature on AFFs, their management continues to pose a challenge to the orthopaedic and extended multi-disciplinary team. The purpose of this review includes evaluation of the current evidence supporting the management of AFFs, clinical and radiological features associated with their presentation and a review of reported surgical strategies to treat and prevent these devastating injures.
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Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Conservadores da Densidade Óssea
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Fraturas do Fêmur
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Fixação Intramedular de Fraturas
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Fraturas do Quadril
Limite:
Humans
Idioma:
En
Revista:
Eur J Orthop Surg Traumatol
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Reino Unido