scholarly journals ¿Tardan más en consolidar las fracturas asociadas a bifosfonatos? [Is the time for consolidation of fractures associated with bisphosphonates higher?]

2019 ◽  
Vol 84 (4) ◽  
pp. 320-327
Author(s):  
Fernando Vanoli ◽  
Luciano Gentile ◽  
Alejandra Beatriz Juarez ◽  
Marcos Sahid Eluani ◽  
Ignacio Pioli ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Femoral Fractures ◽  
Healing Time ◽  
Low Energy ◽  
Control Group ◽  
Cephalomedullary Nail ◽  
Atypical Femoral Fractures ◽  
Treatment Of Osteoporosis ◽  
Femur Fractures ◽  
Atypical Femur Fractures

Introducción: Los bifosfonatos evolucionaron como el pilar para el tratamiento de la osteoporosis, reduciendo la incidencia de fracturas. Recientemente, varias publicaciones describieron la aparición de fracturas atípicas de fémur de baja energía asociadas con el uso de bifosfonatos. El objetivo de este estudio fue evaluar el tiempo promedio de consolidación de las fracturas atípicas de fémur asociadas al tratamiento con bifosfonatos comparado con el de un grupo de control. Materiales y Métodos: Se evaluó, en forma retrospectiva, a 34 mujeres (edad promedio 74 años) con fracturas atípicas; 16 de ellas habían recibido bifosfonatos, al menos, por cinco años. Fueron tratadas entre 2006 y 2017, y estabilizadas con un clavo cefalomedular. Este grupo fue comparado con un grupo de control de similares características. Resultados: Veintidós tenían fracturas subtrocantéricas y 12, diafisarias. El 14% de las que tomaron bifosfonatos y fueron operadas requirió una revisión frente al 5,5% del grupo de control. El tiempo promedio de consolidación fue mayor en las tratadas con bifosfonatos (8.5 vs. 6 meses), con una diferencia estadísticamente significativa (p <0,001).Conclusiones: El beneficio del tratamiento con bifosfonatos en la prevención de fracturas es superior al riesgo de fracturas atípicas; sin embargo, es importante evaluar la relación riesgo-beneficio en cada paciente al comienzo y durante el tratamiento, teniendo en cuenta que, pese a esto, el tiempo de curación es más largo. AbstractIntroduction: Bisphosphonates evolved as the mainstay for the treatment of osteoporosis, reducing the incidence of fractures. Recently, several publications described the occurrence of low-energy atypical femur fractures associated with the use of bisphosphonates. The objective of this work was to study the average time of consolidation of the atypical femoral fractures caused by the consumption of bisphosphonates compared with a control group.Materials and Methods: We retrospectively evaluated 34 patients with atypical femoral fractures of which 16 patients had undergone treatment with bisphosphonates for at least 5 years, treated between 2006 and 2017, and stabilized with a cephalomedullary nail, and were compared with a control group of similar characteristics.Results: All the patients were female. The average age was 74 years. 22 presented subtrochanteric fractures while 12 were diaphyseal. 14% of the subjects who took bisphosphonates and received surgical treatment, required a revision versus 5.5% of the control group. The average time of consolidation was higher in those treated with bisphosphonates (8.5 months vs. 6 months), this being statistically significant (p <0.001).Conclusions: The benefit of treatment with bisphosphonates in the prevention of fractures is greater than the risk of atypical fractures. However, it is important to evaluate the risk-benefit in each patient at the beginning and the duration of the treatment, taking into account that despite this, the healing time is longer.   

scholarly journals Evaluation of the nature and etiologies of risk factors for diaphyseal atypical femoral fractures

2021 ◽  
Author(s):  
Hiroyuki Tsuchie ◽  
Naohisa Miyakoshi ◽  
Yuji Kasukawa ◽  
Koji Nozaka ◽  
Kimio Saito ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analyses ◽  
Femoral Fractures ◽  
Japanese Patients ◽  
High Serum ◽  
Control Group ◽  
Atypical Femoral Fractures ◽  
Factors Affecting ◽  
Lateral Curvature ◽  
Low Serum

Objectives: Differences in the mechanisms of subtrochanteric and diaphyseal atypical femoral fractures (AFFs) have been speculated in studies that have analyzed differences in the patients’ backgrounds. However, the etiologies of each type of AFF have not been investigated in detail. Therefore, this study aimed to investigate the nature and etiologies of the risk factors for diaphyseal AFFs. Materials and Methods: Eighty consecutive Japanese patients with 91 diaphyseal AFFs (the AFF group) and 110 age-matched female patients with osteoporosis (the non-AFF control group) were included. Their clinical data were compared and the factors affecting AFFs were investigated. Furthermore, the etiologies of the risk factors for diaphyseal AFFs were examined. Results: Multivariate analysis revealed that femoral serrated changes, bisphosphonate or denosumab usage, and lateral and anterior femoral curvatures were the risk factors for diaphyseal AFFs (p<0.0011, p=0.0137, and p<0.0001, respectively). Multivariate analyses also revealed that serrated changes and low serum 25(OH)D levels affected the lateral curvature (p=0.0088 and 0.0205, respectively), while serrated changes affected the anterior curvature (p=0.0006); each significantly affected the femoral curvature. In addition, a high serum calcium (Ca) level, lateral femoral curvature, and anterior femoral curvature were the predictors of serrated changes (p=0.0146, 0.0002, and 0.0098, respectively). Conclusion: The risk factors for diaphyseal AFFs were bone resorption inhibitor usage, a strong femoral curvature, and serrated changes. A low serum 25(OH)D level and serrated changes are the risk factors for lateral curvature, while a high serum Ca level is a risk factor for serrated changes.

scholarly journals Role of cephalomedullary nail in proximal femur fractures

2017 ◽  
Vol 3 (5) ◽  
pp. 929
Author(s):  
Nishant Kumar ◽  
Dhruv Sharma ◽  
Kuljit Kumar
Keyword(s):  
Hip Fractures ◽  
Proximal Femur ◽  
Femoral Fractures ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Cephalomedullary Nail ◽  
Proximal Femur Fractures ◽  
Femur Fractures ◽  
Bending Loads ◽  
Cephalomedullary Nails

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Hip fractures are recognized to be a major public health problem. Key determinants of hip fractures include age, osteoporosis, and falls. In these determinants socioeconomic status, have not been well explored. Under eccentric loading, high bending loads occur, leading to failure of the osteosynthetis anchorage at the center of the femoral head.The introduction of the reconstruction nail has broadened the indications for the intramedullary fixation of difficult femoral fractures. The operative technique is however complicated. Some technical difficulties encountered during its use are presented together with guidance to allow these problems to be avoided.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This Study had included 47 cases which were operated by single surgeon and use of different implant (cephalomedullary nail) was randomized irrespective of fracture types and pattern. This study was done over a period of 12 months (October 2013 to October 2014) with 1 month, 3 months, 6 months, 12 months follow up. At every visit patient were assessed as per Oxford hip score. Type of implant used was<strong> </strong>PFNA<strong>,</strong> Intertan<strong>, </strong>Sirus Nail</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The mean age of the patients was 65.68 (±13.55) years. Severe pain was observed among majority of the patients at one month (70.2%) which became mild (40.4%) and moderate (34%) at 3 months. Very mild pain was found in 36.2% patients at 6 months and in 61.7% at 12 months. The limping was all the time among all the patients at one month. However, the limping was found often in 46.8% at 3 months and sometimes in 57.4% at 6 months and 53.2% at 12 months. The hip score was found to be severe among all the patients at one month. However, moderate to severe hip was in 46.8% patients at 3 months, mild to moderate was in 57.4% at 6 months and satisfactory joint function was in 68.1% at 12 months. The comparison of Hip score according to long or short nail at one 3, 6 and 12 months showed no difference. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Cephalomedullary nails with adequate technique so that the lag screws by purchase in the centre-centre or posterior-inferior quadrant combines the benefit of sliding hip screw as well as intramedullary implants. So we recommend the use of cephalomedullary nails in proximal femur fractures especially the unstable fractures.</span></p>

scholarly journals Nontraumatic bilateral atypical femoral fractures associated with long-term alendronate therapy

2020 ◽  
Vol 9 (11) ◽  
pp. 1737
Author(s):  
Olayinka A. Ogundipe
Keyword(s):  
Femoral Fractures ◽  
Case Definition ◽  
Term Therapy ◽  
Caucasian Woman ◽  
X Rays ◽  
Medication History ◽  
Mineral Research ◽  
Atypical Femoral Fractures ◽  
Femur Fractures

Alendronate is a bisphosphonate commonly used in the treatment of post-menopausal and steroid-associated osteoporosis. Bisphosphonates have an evidence base for reducing the occurrence of typical osteoporotic fractures. However, there has been growing recognition of a correlation with the use of long-term therapy with bisphosphonates, and rare occurrence of atypical femoral fractures (AFFs). This report describes a 72-year-old caucasian woman presenting with evolving groin and thigh pains of two weeks duration. Plain X-rays noted features compatible with bilateral impending femoral subtrochanteric fractures. She had been taking oral alendronate 70mg weekly for ten consecutive years as treatment for osteoporosis. Based on the medication history, the absence of preceding trauma or a fall, and the presence of supportive radiological findings, the diagnosis was made of impending bilateral proximal femur fractures secondary to long-term bisphosphonate therapy. The alendronate was discontinued, and the patient managed with two planned successive surgeries involving the insertion of intertrochanteric antegrade nails (inter-TAN) to both femurs. Following a period of rehabilitation, she was successfully discharged home. Some pharmacokinetic and pharmacodynamic considerations of bisphosphonates are discussed. The write-up presents a brief literature review of AFFs. The index report is further reviewed in relation to the American society for bone and mineral research (ASBMR) task force’s recommended case definition of what constitutes AFFs. The discussion concludes with the application of two previously validated causality assessment systems (CAS). In this instance, both CAS indicated a ‘probable’ classification for the adverse drug reaction (ADR) to prolonged usage of oral alendronate.

scholarly journals Infection Versus Hematoma Following Surgical Treatment of Proximal Femoral Fractures in Geriatric Patients

2018 ◽  
Vol 9 ◽  
pp. 215145851775051 ◽  
Author(s):  
Franz Müller ◽  
Michael Galler ◽  
Christina Roll ◽  
Bernd Füchtmeier
Keyword(s):  
Staphylococcus Aureus ◽  
Surgical Treatment ◽  
Geriatric Patients ◽  
Femoral Fractures ◽  
Morbidity And Mortality ◽  
Control Group ◽  
Postoperative Phase ◽  
High Morbidity ◽  
Proximal Femoral Fractures

Introduction: The surgical treatment of proximal femoral fractures predominantly involves geriatric patients and is associated with high morbidity and mortality. However, analyses on postoperative infections or hematoma are rare. Methods: Patients requiring surgical revision due to infection (n = 90) or hematoma (n = 77) in the postoperative phase were identified from an electronic database of 2000 consecutive patients surgically treated for proximal femoral fractures between 2006 and 2014. Demographic and clinical data were retrieved, including information on the pathogens in patients with infection. A follow-up on morbidity and mortality was conducted via telephone for at least 2 years postsurgery. Results: The follow-up rate was 100%, and the mean age was 81.9 years. The incidence rate of infection was 4.1% (90/2000), and women were commonly affected. Staphylococcus aureus and Staphylococcus epidermidis were the most commonly detected pathogens (35.5% and 25.5%, respectively). Mixed infections were observed in 15 patients, and Methicillin-resistant Staphylococcus aureus infections were observed in only 4 patients. A total of 77 (85.6%) infections occurred within 30 days postsurgery. The implant was preserved in 76 (84.4%) patients, and resection arthroplasty was required in 14 patients. Dementia and pertrochanteric fractures were significantly more common in the infection than in the hematoma group. Although infections were associated with high mortality rates for up to 2 years postsurgery, the rates did not significantly differ from those in the hematoma control group. Conclusion: One of every 2 patients who developed an infection following the surgical treatment of a proximal femoral fracture died within 2 years postsurgery. In addition, infections were significantly associated with dementia. Avoiding postoperative infection should be a high priority in the surgical treatment of proximal femoral fractures.

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Atypical femoral fractures: risks and benefits of long-term treatment of osteoporosis with anti-resorptive therapy

2018 ◽  
Vol 178 (3) ◽  
pp. R81-R87 ◽  
Author(s):  
Robert A Adler
Keyword(s):  
Osteoporotic Fracture ◽  
Femoral Fractures ◽  
Osteoporosis Treatment ◽  
Term Treatment ◽  
Atypical Femoral Fractures ◽  
Treatment Of Osteoporosis ◽  
Endocrine Disease ◽  
Long Term Treatment ◽  
Term Management

Modern osteoporosis treatment began in the mid-1990s with the approval of amino-bisphosphonates, anti-resorptive agents that have been shown to decrease osteoporotic fracture risk by about half. In 2005, the first cases of atypical femoral fractures (AFF), occurring in the shaft of the femur, were reported. Since then, more cases have been found, leading to great concern among patients and a dramatic decrease in bisphosphonate prescribing. The pathogenesis and incidence of AFF are reviewed herein. Management and an approach to prevention or early detection of AFF are also provided. Denosumab, a more recently approved anti-resorptive medication has also been associated with AFF. Long-term management of osteoporosis and prevention of fracture are challenging in light of this serious but uncommon side effect, yet with an aging population osteoporotic fracture is destined to increase in frequency.

scholarly journals Is there a familial predisposition to bisphosphonate-induced atypical femoral fractures?

2021 ◽  
Vol 67 (3) ◽  
pp. 370-373
Author(s):  
Mehmet Okçu ◽  
Fatmanur Aybala Koçak ◽  
Samet Sancar Kaya ◽  
Figen Tuncay
Keyword(s):  
Adverse Effect ◽  
Bone Turnover ◽  
Bone Quality ◽  
Genetic Factors ◽  
Femoral Fractures ◽  
Osteoporosis Treatment ◽  
Atypical Femoral Fractures ◽  
Treatment Of Osteoporosis ◽  
Familial Predisposition ◽  
Short Period

Bisphosphonates are commonly used in the treatment of osteoporosis. Atypical femoral fracture (AFF) is a well-known adverse effect of bisphosphonate use. The importance of genetic factors has been demonstrated in bone quality, bone turnover, and in the response to osteoporosis treatment. Herein, we present two cases of bilateral AFFs after bisphosphonate use for a short period of time in members of the same family (mother and her daughter) and discuss genetic predisposition to bisphosphonate-induced AFFs in the light of literature data.

Healing Time and Complications in Operatively Treated Atypical Femur Fractures Associated With Bisphosphonate Use

2016 ◽  
Vol 30 (4) ◽  
pp. 177-181 ◽  
Author(s):  
Yelena Bogdan ◽  
Paul Tornetta ◽  
Thomas A. Einhorn ◽  
Pierre Guy ◽  
Lise Leveille ◽  
...  
Keyword(s):  
Healing Time ◽  
Femur Fractures ◽  
Atypical Femur Fractures

Effectiveness of pre-surgical neuromuscular electrical stimulation on the recovery time of diaphyseal femoral fractures

2020 ◽  
Vol 27 (8) ◽  
pp. 1-15
Author(s):  
María C Bustos ◽  
María S Lo Presti
Keyword(s):  
Electrical Stimulation ◽  
Surgical Treatment ◽  
Recovery Time ◽  
Treatment Time ◽  
Waiting Times ◽  
Intervention Group ◽  
Neuromuscular Electrical Stimulation ◽  
Femoral Fractures ◽  
Control Group ◽  
Men And Women

Background/aims: Quadriceps pathology is common in patients who have suffered diaphyseal femoral fractures because of the long waiting times before surgery, during which they remain immobilised. The aim of this study was to evaluate the effectiveness of neuromuscular electrical stimulation applied in the pre-surgical period on the recovery time of the patients. Methods Before surgical treatment, patients with closed diaphyseal femoral fractures were systematically distributed alternatively into an intervention group and a control group. The intervention group (n=22) received pre-surgical neuromuscular electrical stimulation and the control group (n=25) received conventional physiokinetic treatment. Results Age, gender proportions and time between admission and surgery were similar in both groups. Average treatment time was 14.14 ± 9.7 days. Recovery time (from surgery to medical discharge) was 111 ± 15.65 days for participants in the intervention group, and 139.36 ± 23.05 days for participants in the control group (P<0.0001). No differences were found between men and women nor between the fractured femur (right vs left). Conclusions The results highlight the value of neuromuscular electrical stimulation in the pre-surgical period for patients with diaphyseal femoral fractures, optimising their rehabilitation and facilitating a quicker return to their everyday lives.

scholarly journals Effects of Zoledronate on Mortality and Morbidity after Surgical Treatment of Hip Fractures

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Ömer Cengiz ◽  
Gökhan Polat ◽  
Gökhan Karademir ◽  
Oytun Derya Tunç ◽  
Mehmet Erdil ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
Femoral Fractures ◽  
Harris Hip Score ◽  
Control Group ◽  
Control Groups ◽  
Mortality And Morbidity ◽  
Postoperative Control ◽  
Modified Harris Hip Score ◽  
And Control

We aimed to evaluate the effects of intertrochanteric femoral fractures on mortality, morbidity, and cost of zoledronate treatment in elderly patients treated by osteosynthesis. Based on Evans classification, 114 patients with unstable intertrochanteric femoral fractures were treated with osteosynthesis. After the surgical treatment of intertrochanteric fractures, the treatment group (M/F, 24/32; mean age, 76.7 ± SD years) received zoledronate infusion, and the control group (M/F, 20/38; mean age, 80.2 ± SD years) received placebo. Postoperative control visits were performed at 6-week, 3-month, 6-month, and 12-month time points. Functional level of patients was evaluated by the modified Harris hip score and Merle d’Aubigné hip score. By 12 months, the mean HHS in treatment and control groups was 81.93 and 72.9, respectively. For time of death of the patients, mortality was found to be 57.1% (16/28) on the first 3 months and 92.9% (26/28) on the first six months. The mortality rate in the treatment and control groups was 14.3% (8/56) and 34.5% (20/58), respectively. The use of zoledronic acid after surgical treatment of intertrochanteric femoral fractures in osteoporotic elderly patients is a safe treatment modality which helps to reduce mortality, improves functional outcomes, and has less side effects with single dose use per year.

scholarly journals Strategies for the treatment of femoral fractures in severely injured patients: trends in over two decades from the TraumaRegister DGU®

2021 ◽  
Author(s):  
Felix M. Bläsius ◽  
◽  
Markus Laubach ◽  
Hagen Andruszkow ◽  
Philipp Lichte ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Survival Rates ◽  
Treatment Strategies ◽  
Femoral Fractures ◽  
High Energy ◽  
Trauma Patients ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Femur Fractures ◽  
Injured Patients

Abstract Purpose Treatment strategies for femoral fracture stabilisation are well known to have a significant impact on the patient’s outcome. Therefore, the optimal choices for both the type of initial fracture stabilisation (external fixation/EF, early total care/ETC, conservative treatment/TC) and the best time point for conversion from temporary to definitive fixation are challenging factors. Patients Patients aged ≥ 16 years with moderate and severe trauma documented in the TraumaRegister DGU® between 2002 and 2018 were retrospectively analysed. Demographics, ISS, surgical treatment strategy (ETC vs. EF vs. TC), time for conversion to definitive care, complication (MOF, sepsis) and survival rates were analysed. Results In total, 13,091 trauma patients were included. EF patients more often sustained high-energy trauma (car: 43.1 vs. 29.5%, p < 0.001), were younger (40.6 vs. 48.1 years, p < 0.001), were more severely injured (ISS 25.4 vs. 19.1 pts., p < 0.001), and had higher sepsis (11.8 vs. 5.4%, p < 0.001) and MOF rates (33.1 vs. 16.0%, p < 0.001) compared to ETC patients. A shift from ETC to EF was observed. The time until conversion decreased for femoral fractures from 9 to 8 days within the observation period. Sepsis incidences decreased in EF (20.3 to 12.3%, p < 0.001) and ETC (9.1–4.8%, p < 0.001) patients. Conclusions Our results show the changes in the surgical treatment of severely injured patients with femur fractures over a period of almost two decades caused by the introduction of modern surgical strategies (e.g., Safe Definitive Surgery). It remains unclear which subgroups of trauma patients benefit most from these strategies.

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