title: Atypical femoral fractures in elderly women: a fracture registry-based cohort study.
abstract: 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 ≥ 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.
authors.affiliation: Stavanger University Hospital, Department of Orthopaedic Surgery, PO Box 8100, 4068 Stavanger, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Meling
authors.affiliation: Stavanger University Hospital, Department of Orthopaedic Surgery, PO Box 8100, 4068 Stavanger, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Nawab
authors.affiliation: Stavanger University Hospital, Department of Orthopaedic Surgery, PO Box 8100, 4068 Stavanger, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Harboe
authors.affiliation: Stavanger University Hospital, Department of Orthopaedic Surgery, PO Box 8100, 4068 Stavanger, Norway.
authors.forename: L
authors.initials: L
authors.lastname: Fosse
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D042241:Early Diagnosis; D005260:Female; D005264:Femoral Fractures / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D011300:Preoperative Care / Q000706:statistics & numerical data; D011475:Prosthesis Failure; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Atypical femoral fracture; Bisphosphonate; Fracture registry; Incidence; Peri-implant fracture