Factors Affecting the Second Complete Atypical Femoral Fracture after the First Atypical Fracture.

OBJECTIVES: Atypical femoral fracture (AFF) is an atypical low-energy subtrochanteric and diaphyseal femoral fracture. Even if bone fusion is achieved in patients with AFF, the risk of AFF in the contralateral femur must be considered. This study aimed to investigate the factors affecting complete AFF in the contralateral femur and conservatively treated incomplete AFF. SUBJECT AND METHODS: Radiographs of 111 femurs in 104 AFF cases were examined, and the femurs were classified as follows: 85 contralateral femurs with complete AFF; 18 contralateral femurs with incomplete AFF; 8 femurs with incomplete AFF without surgical treatment. Various patients' clinical data were collected, and we investigated the factors affecting the second complete AFF. RESULTS: Complete fractures occurred in 10 (9.7%) of 103 femurs without incomplete AFF at the first visit and in 3 (37.5%) of 8 femurs with incomplete AFF. The Kaplan-Meier curve revealed that lateral cortical bone thickening and thigh pain were associated with significantly poorer prognoses (p = 0.026 and p = 0.013, respectively). Multivariate analyses revealed that eldecalcitol usage after AFF onset (p = 0.0094) and previous use of bisphosphonate or denosumab (p = 0.0126) were protective factors for second complete AFF and that the presence of thigh pain (p = 0.0134) was a risk factor for second complete AFF. CONCLUSIONS: Eldecalcitol administration after bone union of first AFF may prevent AFF recurrence. In addition, painful incomplete AFF has a high risk of developing a complete fracture.

[Transcatheter arterial embolization in the treatment of facial injury].

BACKGROUND: Maxillofacial injuries may be associated with a variety of problems including airway obstruction and hemorrhage. We studied retrospectively the patients who underwent transcatheter arterial embolization for facial hemorrhage. METHODS: We retrospectively evaluated medical charts of the 12 patients who underwent transcatheter arterial embolization for facial hemorrhage between January, 2000 and December, 2006. We decided clinical outcome using Glasgow Outcome Scale (GOS) and classified the patients into the favorable outcome group (GR: good recovery, MD: moderate disability), and poor outcome group (D: dead). We compared the two groups regarding blood pressure, pulse rate. Glasgow Coma Scale (GCS), Injury Severity Score (ISS), transufused volume, interval between injury and embolization. RESULTS: From 12 cases reviewed, nine were males and three were females. The mean age was 42 years (20-73 years). Three patients were GR, one patient was MD, and eight patients were D. In the poor outcome group, shock signs were more common, and GCS was lower. The ISS was correlated with the outcome. The mean interval between injury and embolization was 3.5 hours. CONCLUSION: Patients with maxillofacial injuries may be fatal. Airway and breathing maintenance are most important. When pressure and packing fail to control the hemorrhage, prompt transcatheter arterial embolization may be effective.