Skip to main content

Advertisement

SpringerLink
Log in

Atypical femur fractures: a survey of current practices in orthopedic surgery

  • Short Communication
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

The results of a self-administered online survey demonstrate that orthopedic surgeons’ management practices for AFF are variable. These data will inform the development of clinical practice guidelines.

Introduction

We aimed to determine current AFF treatment practices of orthopedic surgeons to inform clinical practice guideline development.

Methods

A self-administered online survey was developed and sequentially posted on the Orthopaedic Trauma Association (OTA) website from July to August 2015 and the Canadian Orthopaedic Association (COA) website from December 2015 to January 2016. Level of confidence in diagnosis and treatment as well as treatment preferences between respondents who self-identified as trauma surgeons vs. non-trauma surgeons were compared.

Results

A total of 172 completed surveys were obtained (OTA, N = 100, 58%; COA, N = 72, 8%). Seventy-eight percent of respondents had treated ≥1 AFF in the previous 6 months. Seventy-six percent reported feeling extremely or very confident in diagnosing AFF (trauma 84% vs. non-trauma surgeons 70%, p = 0.04), and 63% reported feeling extremely or very confident in treating AFF (trauma 82%, non-trauma surgeons 50%, p < 0.01). Preferred management for complete and symptomatic incomplete AFFs was surgical fixation with a cephalomedullary nail (CMN) by 88 and 79%, respectively, while close follow-up was preferred for asymptomatic incomplete AFFs in 72% of respondents. Trauma surgeons used the CMN more frequently than non-trauma surgeons (90 vs. 76% p = 0.03). In patients with bilateral AFFs, with one side surgically treated, 56% were extremely likely to surgically treat the contralateral side, if symptomatic. Most felt guidelines (81%) and educational resources (73%) would be valuable.

Conclusions

Current orthopedic treatment practices for AFFs are variable. The results of this survey will inform the development of practice guidelines and educational resources.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Kanis JA, Johnell O, Oden A et al (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11:669

    Article  CAS  PubMed  Google Scholar 

  2. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S et al (2010) 2010 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada: summary. Can Med Assoc J 182(17):1864–1873

    Article  Google Scholar 

  3. Shane E et al (2014) Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 29(1):1–23

    Article  PubMed  Google Scholar 

  4. Feldstein AC, Black D, Perrin N et al (2012) Incidence and demography of femur fractures with and without atypical features. J Bone Miner Res 27:977–986

    Article  PubMed  Google Scholar 

  5. Schilcher J, Koeppen V, Aspenberg P, Michaëlsson K (2014) Risk of atypical femoral fracture during and after bisphosphonate use. N Engl J Med 371:974–976

    Article  PubMed  Google Scholar 

  6. Sellmeyer DE (2010) Atypical fractures as a potential complication of long-term bisphosphonate therapy. JAMA 304(13):1480–1484

    Article  CAS  PubMed  Google Scholar 

  7. Weil YA et al (2011) The outcome of surgically treated femur fractures associated with long-term bisphosphonate use. J Trauma-Inj Infect Crit Care 71(1):186–190

    Article  CAS  Google Scholar 

  8. Grady M, Watson JT, Cannada L (2012) Treatment of femoral fracture nonunion after long-term bisphosphonate use. Orthopedics 35(6):e991–e995

    Article  PubMed  Google Scholar 

  9. Wang Z, Bhattacharyya T (2011) Trends in incidence of subtrochanteric fragility fractures and bisphosphonate use among the US elderly, 1996–2007. J Bone Miner Res 26(3):553–560

    Article  CAS  PubMed  Google Scholar 

  10. Park-Wyllie LY et al (2011) Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA 305(8):783–789

    Article  CAS  PubMed  Google Scholar 

  11. Dillman DA, Smyth JD, Christian LM (2009) Internet, mail, and mixed-mode surveys: the tailored design method, 3rd edn. Wiley, New York

    Google Scholar 

  12. Banffy MB, Vrahas MS, Ready JE, Abraham JA (2011) Nonoperative versus prophylactic treatment of bisphosphonate-associated femoral stress fractures. Clin Orthop Relat Res 469(7):2028–2034. doi:10.1007/s11999-011-1828-8

    Article  PubMed  PubMed Central  Google Scholar 

  13. Probyn L, Cheung AM, Lang C, Lenchik L, Adachi JD, Khan A et al (2015) Bilateral atypical femoral fractures: how much symmetry is there on imaging? Skelet Radiol 44(11):1579–1584. doi:10.1007/s00256-015-2212-7

    Article  Google Scholar 

  14. Capeci CM, Tejwani NC (2009) Bilateral low-energy simultaneous or sequential femoral fractures in patients on long-term alendronate therapy. J Bone Joint Surg Am 91:2556–2561

    Article  PubMed  Google Scholar 

  15. Prasarn ML, Ahn J, Helfet DL, Lane JM, Lorich DG (2012) Bisphosphonate-associated femur fractures have high complication rates with operative fixation. Clin Orthop Relat Res 470(8):2295–2301. doi:10.1007/s11999-012-2412-6

    Article  PubMed  PubMed Central  Google Scholar 

  16. Egol KA, Park JH, Rosenberg ZS, Peck V, Tejwani NC (2014) Healing delayed but generally reliable after bisphosphonate-associated complete femur fractures treated with IM nails. Clin Orthop Relat Res 472(9):2728–2734

    Article  PubMed  Google Scholar 

  17. Morin SN, Wall M, Belzile EL, Godbout B, Moser TP, Michou L et al (2015) Assessment of femur geometrical parameters using EOS™ imaging technology in patients with atypical femur fractures; preliminary results. Bone. doi:10.1016/j.bone.2015.10.016

  18. Peichl P, Holzer LA, Maier R, Holzer G (2011) Parathyroid hormone 1–84 accelerates fracture-healing in pubic bones of elderly osteoporotic women. J Bone Joint Surg 93(17):1583–1587. doi:10.2106/JBJS.J.01379

    Article  PubMed  Google Scholar 

  19. Aspenberg P, Johansson T (2010) Teriparatide improves early callus formation in distal radial fractures. Acta Orthop 81(2):234–236. doi:10.3109/17453671003761946

    Article  PubMed  PubMed Central  Google Scholar 

  20. Chiang CY, Zebaze RM, Ghasem-Zadeh A, Iuliano-Burns S, Hardidge A, Seeman E (2013) Teriparatide improves bone quality and healing of atypical femoral fractures associated with bisphosphonate therapy. Bone 52(1):360–365

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

AM Cheung holds a Canada Research Chair in Musculoskeletal and Postmenopausal Health. SNM is a clinician-scientist scholar of the Fonds de Recherche du Québec en Santé.

Contributions

All authors substantially contributed to conception (PSS, MW, SNM), design (PSS, MW, SNM), analysis (PSS, MW SNM), and interpretation of data (all); drafting the article (PSS, MW, SNM) or revising it critically for important intellectual content (all); and final approval of the version to be published (all). PSS and SNM accept full responsibility for the work and/or the conduct of the study, had full access to all the data, and controlled the decision to publish.

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Orthopaedic Trauma, Foothills Medical Centre, University of Calgary, McCaig Tower, 3134 Hospital, Drive NW, Calgary, AB, T2N 5A1, Canada

    P. S. Schneider

  2. Research Institute of the McGill University Health Center, Montreal, Canada

    M. Wall, E. J. Harvey & S. N. Morin

  3. Department of Medicine, Laval University, Quebec City, Canada

    J. P. Brown

  4. Department of Medicine, University of Toronto, Toronto, Canada

    A. M. Cheung

  5. Department of Surgery, McGill University, Montreal, Canada

    E. J. Harvey

  6. Department of Medicine, McGill University, Montreal, Canada

    S. N. Morin

Authors
  1. P. S. Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Wall
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. P. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. M. Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. J. Harvey
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. N. Morin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. S. Schneider.

Ethics declarations

Conflicts of interest

Prism S Schneider: no conflict.

Michelle Wall: no conflict.

Jacques P Brown: research grants (paid to institution) and/or consulting or speaking fees from Amgen, Eli Lilly, Mantra, Merck, Takeda.

Angela M Cheung: research grants (paid to institution) and/or consulting from Amgen, Eli Lilly and Merck.

Edward J Harvey: chairman of the board—co-founder of NXTSens Inc., chief medical officer—Greybox Healthcare, Institutional Support: JandJ-DepuySynthes, ZimmerBiomet, board member of Orthopaedic Trauma Association, Canadian Orthopaedic Association, editor in chief of Canadian Journal of Surgery.

Suzanne N Morin: research grants (paid to institution): Amgen and Merck.

Funding

This project was funded by a grant from the Canadian Institutes of Health Research (CIHR 2010.09.15; No. 230833).

Electronic supplementary material

ESM 1

(PPTX 68 kb).

ESM 2

(DOCX 75 kb).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schneider, P.S., Wall, M., Brown, J.P. et al. Atypical femur fractures: a survey of current practices in orthopedic surgery. Osteoporos Int 28, 3271–3276 (2017). https://doi.org/10.1007/s00198-017-4155-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-017-4155-4

Keywords

Search

Navigation