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Atypical femur fracture

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https://www.readbyqxmd.com/read/29065818/antiresorptives-safety-concerns-clinical-perspective
#1
Jacques P Brown
Antiresorptive drugs, such as amino-bisphosphonates and denosumab (Dmab), have dominated osteoporosis therapies for over 20 years. Since osteoporosis is a chronic disease, antifracture therapy could continue for the rest of a patient's life. Phase III clinical trials for antiresorptive drugs assessed relatively small patient populations for short durations and excluded up to 80% of patients who might seek osteoporosis therapy in clinical practice. Postmarketing reports based upon millions of patient-years and long-term (>5 years) clinical administration have associated some previously unknown, rare adverse events with antiresorptive use including osteonecrosis of the jaw (ONJ) and atypical femur fractures (AFFs)...
January 1, 2017: Toxicologic Pathology
https://www.readbyqxmd.com/read/28976433/t-score-discordance-of-bone-mineral-density-in-patients-with-atypical-femoral-fracture
#2
Kyung-Jae Lee, Byung-Woo Min, Kwang-Soon Song, Ki-Cheor Bae, Chul-Hyun Cho, Si-Wook Lee
BACKGROUND: Although atypical femoral fracture (AFF) occurs more frequently in patients taking bisphosphonates and longer treatment is associated with higher risk, the causal relationship between AFF and bisphosphonates has not been established. Most patients with AFF have osteoporosis that is being treated with bisphosphonates, but we are not aware of any reports regarding the areal bone mineral density (aBMD) and discordance between the T-scores of the femur and spine in such patients...
October 4, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28924690/lateral-fixation-an-alternative-surgical-approach-in-the-prevention-of-complete-atypical-femoral-fractures
#3
Mohammad Kharazmi, Karl Michaëlsson, Pär Hallberg, Jörg Schilcher
Little evidence is available on how to treat incomplete atypical fractures of the femur. When surgery is chosen, intramedullary nailing is the most common invasive technique. However, this approach is adopted from the treatment of other types of ordinary femoral fracture and does not aim to prevent the impending complete fracture by interrupting the mechanism underlying the pathology. We suggest a different surgical approach that intends to counteract the underlying biomechanical conditions leading to a complete atypical fracture and thus could be better suited in selected cases...
September 18, 2017: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
https://www.readbyqxmd.com/read/28878545/atraumatic-segmental-atypical-femur-fracture-secondary-to-bisphosphonate-use-a-case-report
#4
Andrew J Lovy, Diana Patterson, Laura Skeeles, Richard Ghillani, David Joseph, Yangguan Wu, Rohit Hasija
Atypical femur fractures as a result of long term bisphosphonate use are characterized by several unique radiographic features. We describe an atypical femur fracture treated by cephalomedullary nail with a previously undescribed segmental fracture pattern. Other than 1.5 years of bisphosphonate use the patient did not have any other risk factors known to cause atypical femur fractures. Judicious bisphosphonate use as well as increased awareness of the associated complications may help reduce the rate of bisphosphonate associated atypical femur fractures...
August 2017: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/28876272/intramedullary-nail-fixation-of-atypical-femur-fractures-with-bone-marrow-aspirate-concentrate-leads-to-faster-union-a-case-control-study-erratum
#5
(no author information available yet)
No abstract text is available yet for this article.
September 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28844196/atypical-femoral-fracture-associated-with-bone-modifying-agent-for-bone-metastasis-of-breast-cancer-a-report-of-two-cases
#6
Daisuke Tateiwa, Hidetatsu Outani, Saya Iwasa, Yoshinori Imura, Takaaki Tanaka, Kazuya Oshima, Norifumi Naka, Nobuhito Araki
Atypical femoral fractures (AFFs) are recently observed as a complication of long-term bone-modifying agent (BMA; bisphosphonate or denosumab) therapy for bone metastases. We describe the cases of two women diagnosed with breast cancer who developed incomplete AFF associated with BMAs prescribed for bone metastases. Radiographs of their femurs revealed thickening of the lateral subtrochanteric cortex, and tomosynthesis revealed a visible fracture line in the thickened cortex. They were initially treated with conservative management; however, the incomplete fracture resulted in a complete fracture...
September 2017: Journal of Orthopaedic Surgery
https://www.readbyqxmd.com/read/28796551/lateral-cortical-thickening-and-bone-heterogeneity-of-the-subtrochanteric-femur-measured-with-quantitative-ct-as-indicators-for-early-detection-of-atypical-femoral-fractures-in-long-term-bisphosphonate-users
#7
Seung Hyun Lee, Young Han Lee, Jin-Suck Suh
OBJECTIVE: The objective of our study was to compare subtrochanteric femur bone mineral density (BMD) and bone quality of long-term bisphosphonate (BP) users who sustained an atypical femoral fracture (AFF) with BP users who did not sustain a femoral fracture and BP-naïve patients with no history of femoral fracture using quantitative CT (QCT). MATERIALS AND METHODS: Fourteen female BP users with an AFF (mean age, 72.6 years; mean duration of BP use, 6.2 years; mean body mass index, 21...
October 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28770350/surgical-outcomes-of-intramedullary-nailing-for-diaphyseal-atypical-femur-fractures-is-it-safe-to-modify-a-nail-entry-in-bowed-femur
#8
Ji Wan Kim, Hyunuk Kim, Chang-Wug Oh, Joon-Woo Kim, Oog-Jin Shon, Young-Soo Byun, Jung Jae Kim, Hyoung Keun Oh, Hiroaki Minehara, Kyu-Tae Hwang, Ki Chul Park
INTRODUCTION: The purpose of the study was to determine the surgical outcomes of intramedullary nailing in diaphyseal atypical femoral fractures (AFFs) and to evaluate the clinical outcomes of nail entry modification technique. MATERIALS AND METHODS: We retrospectively reviewed diaphyseal AFFs treated with IMN at nine institutions. In total, 82 patients were included. Surgical outcomes such as complication, union time, and femoral bowing were evaluated. We modified the nail entry of the straight nail from piriformis fossa to the tip of the greater trochanter in the bowed femur and compared the surgical outcomes between the original group and the modification group...
August 2, 2017: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/28770273/atypical-femur-fractures-a-survey-of-current-practices-in-orthopedic-surgery
#9
P S Schneider, M Wall, J P Brown, A M Cheung, E J Harvey, S N Morin
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...
November 2017: Osteoporosis International
https://www.readbyqxmd.com/read/28748389/predisposing-factors-associated-with-atypical-femur-fracture-among-postmenopausal-korean-women-receiving-bisphosphonate-therapy-8%C3%A2-years-experience-in-a-single-center
#10
J H Koh, J P Myong, J Yoo, Y-W Lim, J Lee, S-K Kwok, S-H Park, J H Ju
The risk factors for atypical femur fracture in patients exposed to bisphosphonates for at least 1 year were examined. Prolonged and continuous use of bisphosphonates, long-term use of glucocorticoids, and a higher body mass index were associated with increased risk of atypical femur fracture. INTRODUCTION: The purpose of the present study is to determine whether rheumatoid arthritis (RA) and other clinical factors are associated with an increased risk of bisphosphonate (BP)-related atypical femur fracture (AFF)...
November 2017: Osteoporosis International
https://www.readbyqxmd.com/read/28731209/evaluating-atypical-features-of-femur-fractures-how-change-in-radiological-criteria-influenced-incidence-and-demography-of-atypical-femur-fractures-in-a-community-setting
#11
Erin S LeBlanc, A Gabriela Rosales, Dennis M Black, Harry K Genant, Richard M Dell, Darin M Friess, David L Boardman, Douglas C Bauer, Anne de Papp, Arthur C Santora, Eric S Orwoll
Identification of atypical femoral fractures (AFFs) can be challenging. To assist in the radiological assessment, an American Society for Bone and Mineral Research (ASBMR) Task Force developed a case definition for AFFs in 2010, revising it in 2013. How the revised definition performs in a community setting compared with the 2010 definition is unknown. We applied the 2013 criteria to 372 femoral fractures that occurred between January 1, 1996, and June 30, 2009, employing two independent expert physician reviewers...
November 2017: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
https://www.readbyqxmd.com/read/28632656/intramedullary-nail-fixation-of-atypical-femur-fractures-with-bone-marrow-aspirate-concentrate-leads-to-faster-union-a-case-control-study
#12
Andrew J Lovy, Jun S Kim, John Di Capua, Sulaiman Somani, Stephanie Shim, Aakash Keswani, Rohit Hasija, Yangguan Wu, David Joseph, Richard Ghillani
OBJECTIVES: To evaluate bone marrow aspirate concentrate (BMAC) use in the treatment of AFF. DESIGN: Retrospective case control. SETTING: Level 1 trauma center. PATIENTS: Complete AFF, defined according to American Society of Bone and Mineral Research (ASBMR) criteria, from September 2009 to April 2015 with minimum 1-year follow-up. INTERVENTION: Operative treatment with antegrade intramedullary nails...
July 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28612307/atypical-subtrochanteric-fractures-in-korean-hip-fracture-study
#13
Y-K Lee, T-Y Kim, Y-C Ha, S-H Song, J W Kim, H C Shon, J S Chang, K-H Koo
In Korean, atypical subtrochanteric fractures (ASF) were rare. Higher BMI and use of bisphosphonate were significant risk factors of ASF. INTRODUCTION: Recently, ASF have been reported to increase among patients on bisphosphonate. However, the incidence of ASF and the association between ASF and bisphosphonate use have not been well defined in Asian population. Our purposes are (1) to estimate the proportion of ASF among Korean patients with proximal femur fracture and (2) to determine the associated risk factors of ASF in the Korean patients...
June 14, 2017: Osteoporosis International
https://www.readbyqxmd.com/read/28535898/treatment-of-postmenopausal-osteoporosis-a-literature-based-algorithm-for-use-in-the-public-health-care-system
#14
Ellen Luz Pereira Caires, Mailze Campos Bezerra, Ana Flávia Torquato de Araújo Junqueira, Sheila Márcia de Araújo Fontenele, Silvana Cristina de Albuquerque Andrade, Catarina Brasil d'Alva
Bisphosphonates are considered first-line agents in the treatment of postmenopausal osteoporosis based on extensive experience of use, safety, and proven efficacy in reducing vertebral, non-vertebral and femur fractures. However, post-marketing reports based on the treatment of millions of patients/year over lengthy periods of time have revealed the occurrence of initially unexpected adverse effects, such as osteonecrosis of the jaw and atypical femoral fracture, leading to the restriction of treatment duration with bisphosphonates by global regulatory agencies...
May 2017: Revista Brasileira de Reumatologia
https://www.readbyqxmd.com/read/28487299/the-first-reported-case-of-atypical-femoral-fracture-caused-by-daily-ibandronate-prescribed-for-bone-metastases-in-breast-cancer
#15
Robert Espey, Stephanie Grimes, Gary Heyburn, William David Kealey
A 55-year-old woman with bony metastatic breast cancer was commenced on daily ibandronic acid to prevent skeletal related events (SREs). Four years later, she began to experience new lower limb and groin pain with investigations leading to the suspicion of further metastatic spread to her left femur. While awaiting radiotherapy for this, she unfortunately tripped and fell sustaining a fracture to the proximal third of her left femur. Radiographic findings of her femur from both before and after the fall were suggestive of an atypical femoral fracture, presumed secondary to her bisphosphonate therapy rather than metastatic spread...
May 9, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28476576/non-bmd-dxa-measurements-of-the-hip
#16
Clinten P Edmondson, Elliott N Schwartz
Hip fracture is one of the most serious complications of osteoporosis. More than 50% of hip and other fractures occur in patients without densitometric osteoporosis. Therefore, areal bone mineral density (aBMD) may not be the best way to assess fracture risk. In order to improve assessment of fracture risk, many other approaches have been taken. At the present time, the Fracture Risk Algorithm (FRAX©) is one of the most notable ways to improve assessment of fracture risk. However, since early in the initiation of the dual energy x-ray absorptiometry (DXA) era, several non-BMD DXA approaches to the assessment of hip fracture risk have been proposed...
November 2017: Bone
https://www.readbyqxmd.com/read/28467663/screening-for-atypical-femur-fractures-using-extended-femur-scans-by-dxa
#17
Denise M van de Laarschot, Alexandra Aa Smits, Sanne Kc Buitendijk, Merel T Stegenga, M Carola Zillikens
Atypical femur fractures (AFFs) are a rare but serious complication associated with the use of antiresorptive drugs such as bisphosphonates. Assessment of incomplete AFFs on extended femur scans by dual-energy X-ray absorptiometry (DXA) may prevent the development of complete fractures. The aim of this study was to evaluate the potential of extended femur scans by DXA as a screening tool for incomplete AFFs. From June 2014 until September 2016, extended femur scans were routinely performed in all consecutive patients undergoing DXA scanning who had used bisphosphonates or denosumab at any given moment in the previous year...
May 3, 2017: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
https://www.readbyqxmd.com/read/28463916/intramedullary-nailing-for-atypical-femoral-fracture-with-excessive-anterolateral-bowing
#18
COMPARATIVE STUDY
Young-Chang Park, Hyung-Keun Song, Xuan-Lin Zheng, Kyu-Hyun Yang
BACKGROUND: Intramedullary nailing is the treatment of choice for atypical femoral fractures. However, several problems, such as iatrogenic fracture and medial gap opening, can occur during intramedullary nailing when atypical femoral fractures are associated with excessive anterolateral bowing. To overcome these problems, we have developed a new grading system for anterolateral femoral bowing and a new technique for intramedullary nailing. The core of this new technique is matching the anterior curvature of the femoral nail with the anterolateral bowing of the femur when the nail passes the apex of the curvature, by rotating the nail externally...
May 3, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28459066/atypical-femoral-shaft-fractures-in-female-bisphosphonate-users-were-associated-with-an-increased-anterolateral-femoral-bow-and-a-thicker-lateral-cortex-a-case-control-study
#19
Seung Pil Jang, Ingwon Yeo, Sang-Yeon So, Keunbyuel Kim, Young-Wan Moon, Youn-Soo Park, Seung-Jae Lim
The purpose of our study was to investigate the radiographic characteristics of atypical femoral shaft fractures (AFSFs) in females with a particular focus on femoral bow and cortical thickness. We performed a fracture location-, age-, gender-, and ethnicity-matched case-control study. Forty-two AFSFs in 29 patients and 22 typical osteoporotic femoral shaft fractures in 22 patients were enrolled in AFSF group and control group, respectively. With comparing demographics between two groups, radiographically measured femoral bow and cortical thicknesses of AFSF group were compared with control group...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28456365/medication-management-after-intramedullary-nailing-of-atypical-fractures
#20
Jean-Marc Feron, Adeline Cambon-Binder
Long term use of bisphosphonates (BPs) in osteoporotic patients may be associated with stress fractures of the sub-trochanteric and shaft area of the femur, so called "atypical" femoral fractures (AFF). Specific diagnosis criteria have been defined with 5 major features; the presence of four of them characterizes the AFF. Once a complete fracture occurred, the best surgical treatment is closed reduction and intra medullary nailing. The BPs treatment should be stopped immediately after an AFF occurred. Dietary calcium and vitamin D status should be assessed, and adequate supplementation prescribed...
June 2017: Injury
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