Atypical femoral fractures in elderly women

• Published in: Journal of bone and joint surgery. British volume Vol. 96-B; no. 8; pp. 1035 - 1040
• Main Authors: Meling, T, Nawab, A, Harboe, K, Fosse, L
• Format: Journal Article
• Language: English
• Published: 01.08.2014
• ISSN: 0301-620X
• DOI: 10.1302/0301-620X.96B8.33306

An atypical femoral fracture (AFF), with a transverse fracture radiologically through the lateral cortex is a rare but serious condition. In order to improve our ability to identify patients with this condition, we retrospectively surveyed all subtrochanteric, peri-implant and diaphyseal femoral fractures in patients aged greater than or equal to 65 years who underwent surgical treatment at our hospital between 2004 and 2011.We describe the incidence of atypical fractures and their characteristics, with observational data including a review of the hospital and general practitioner records. Clinical outcomes were evaluated using the Harris hip score (HHS) and the timed up-and-go (TUG) test.Atypical fractures only occurred in women with an incidence of 9.8 per 100 000 person-years. The incidence in those who were treated with bisphosphonates was 79.0 per 100 000 person-years; eight of 17 fractures occurred around metal implants. There was a high incidence of delayed union and revision surgery. A total of nine patients (ten AFFs) were available for review at a mean follow-up of 36.5 months (10 to 104). The clinical outcome was poor with a mean HHS of 58.9 (95% CI 47.4 to 70.4) and a mean TUG test of 25.7 s (95% CI 12.7 to 38.8).The delay in diagnosis and treatment of AFF may result from a lack of knowledge of this condition.Cite this article: Bone Joint J 2014; 96-B:1035-40.