title: Healing Time and Complications in Operatively Treated Atypical Femur Fractures Associated With Bisphosphonate Use: A Multicenter Retrospective Cohort.
abstract: OBJECTIVE
  The purpose of this study was to characterize demographics, healing time, and complications of a large series of operatively treated atypical femur fractures.
  
  
  METHODS
  Retrospective multicenter review.
  
  
  METHODS
  Seventeen academic medical centers.
  
  
  METHODS
  Bisphosphonate-related fractures as defined by American Society of Bone and Mineral Research. Fractures had to be followed for at least 6 months or to union or revision.
  
  
  METHODS
  Operative treatment of bisphosphonate-related fracture.
  
  
  METHODS
  Union time and complications of treatment, as well as information about the contralateral limb.
  
  
  RESULTS
  There were 179 patients, average age 72, average body mass index 27.2. Average follow-up was 17 months. Twenty-one percent had a previous history of fragility fracture; 34% had prodromal pain. Most (88%) lived independently before injury. Thirty-one percent had radiographic changes suggesting stress reaction. Surgical fixation was with cephalomedullary nail (51%), IM nail (48%), or plate (1%). Complications included death (4), PE (3), and wound infection (6). Twenty (12%) patients underwent revision at an average of 11 months. Excluding revisions, average union time was 5.2 months. For revisions, union occurred at an average of 10.2 months after intervention. No association was identified between discontinuation of bisphosphonates and union time (P = 0.5) or need for revision (P = 0.7). Twenty-one percent sustained contralateral femur fractures; 32% of these had pain and 59% had stress reaction before contralateral fracture.
  
  
  CONCLUSIONS
  In this series, surgery had a 12% failure rate and delayed average time to union. Twenty-one percent developed contralateral femur fractures within 2 years, underscoring the need to evaluate the contralateral extremity.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Boston University Medical Center, Boston MA; †University of British Columbia, Vancouver, BC, Canada; ‡Dalhousie University, Halifax, Canada; §Carolinas Medical Center, Charlotte, NC; ‖Geisinger, Danville, PA; ¶Orthopaedic Associates of Michigan, Grand Rapids, MI; **St. Michael's Hospital, Toronto, Canada; ††Tampa General Hospital, Tampa, FL; ‡‡Scott & White Hospital, Temple, TX; §§Washington University-St Louis, St Louis, MO; ‖‖MetroHealth Medical Center, Cleveland, OH; ¶¶London Health Science Center, London, Ontario, Canada; ***Lahey Clinic, Burlington, MA; †††University of Utah, Salt Lake City, UT; ‡‡‡Fort Worth, TX; §§§Stony Brook University, Stony Brook, NY; and ‖‖‖Oregon Health and Sciences University, Portland, OR.
authors.forename: Yelena
authors.initials: Y
authors.lastname: Bogdan
authors.forename: Paul
authors.initials: P
authors.lastname: Tornetta
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Einhorn
authors.forename: Pierre
authors.initials: P
authors.lastname: Guy
authors.forename: Lise
authors.initials: L
authors.lastname: Leveille
authors.forename: Juan
authors.initials: J
authors.lastname: Robinson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bosse
authors.forename: Nikkole
authors.initials: N
authors.lastname: Haines
authors.forename: Daniel
authors.initials: D
authors.lastname: Horwitz
authors.forename: Clifford
authors.initials: C
authors.lastname: Jones
authors.forename: Emil
authors.initials: E
authors.lastname: Schemitsch
authors.forename: Claude
authors.initials: C
authors.lastname: Sagi
authors.forename: Bryan
authors.initials: B
authors.lastname: Thomas
authors.forename: Daniel
authors.initials: D
authors.lastname: Stahl
authors.forename: William
authors.initials: W
authors.lastname: Ricci
authors.forename: Megan
authors.initials: M
authors.lastname: Brady
authors.forename: David
authors.initials: D
authors.lastname: Sanders
authors.forename: Michael
authors.initials: M
authors.lastname: Kain
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Higgins
authors.forename: Cory
authors.initials: C
authors.lastname: Collinge
authors.forename: Stephen
authors.initials: S
authors.lastname: Kottmeier
authors.forename: Darin
authors.initials: D
authors.lastname: Friess
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D004164:Diphosphonates / Q000008:administration & dosage* / Q000009:adverse effects; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000706:statistics & numerical data*; D017102:Fracture Healing / Q000187:drug effects*; D006620:Hip Fractures / Q000139:chemically induced / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates