Post-operative outcomes of atypical femoral subtrochanteric fracture in patients on bisphosphonate therapy.
Management of bisphosphonate-associated subtrochanteric fractures remains opinion- or consensus-based. There are limited data regarding the outcomes of this fracture. We retrospectively reviewed 33 consecutive female patients with a mean age of 67.5 years (47 to 91) who were treated surgically between May 2004 and October 2009. The mean follow-up was 21.7 months (0 to 53). Medical records and radiographs were reviewed to determine the post-operative ambulatory status, time to clinical and radiological union and post-fixation complications such as implant failure and need for second surgery. The predominant fixation method was with an extramedullary device in 23 patients. 25 (75%) patients were placed on wheelchair mobilisation or no weight-bearing initially. The mean time to full weight-bearing was 7.1 months (2.2 to 29.7). The mean time for fracture site pain to cease was 6.2 months (1.2 to 17.1). The mean time to radiological union was 10.0 months (2.2 to 27.5). Implant failure was seen in seven patients (23%, 95 confidence interval (CI) 11.8 to 40.9). Revision surgery was required in ten patients (33%, 95 CI 19.2 to 51.2). A large proportion of the patients required revision surgery and suffered implant failure. This fracture is associated with slow healing and prolonged post-operative immobility.
Department of Orthopaedic Surgery, Singapore General Hospital, Block 145, Bishan Street 11, 09-99, 570145, Singapore.
B J X
BJ
Teo
J S B
JS
Koh
S K
SK
Goh
M A
MA
Png
D T C
DT
Chua
T S
TS
Howe
D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001858:Bone Nails; D001863:Bone Screws; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D015775:Fractures, Stress / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000601:surgery*; D006620:Hip Fractures / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011184:Postoperative Period; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D016474:Weight-Bearing
D050071:Bone Density Conservation Agents; D004164:Diphosphonates
atypical subtrochanter fracture bisphosphonate union outcome