title: Surgical outcome of intramedullary nailing in patients with complete atypical femoral fracture: A multicenter retrospective study.
abstract: BACKGROUND
  Management of atypical femoral fracture on bisphosphonate therapy still remains controversy and is reported high rate of complications. The aim of this study was to evaluate the outcome of intramedullary nailing in patients with atypical femoral fracture who took bisphosphonate more than one year through the multicenter retrospective study.
  
  
  METHODS
  We gathered 75 atypical femoral fractures from seven institutions between 2009 and 2014. Among them 46 atypical femoral fractures which met the inclusion criteria was evaluated in this study. The average age was 70.1 years (53-80) and the average duration of bisphosphonate use was 5.1 years (1-15 years). Medical records and radiographs were reviewed to determine time to union, union rate, need for revision surgery, restoration of ambulatory function, and complications.
  
  
  RESULTS
  Twenty-nine (63%) fractures healed within 6 months without complications. The average time to union except two non-union was 24.9 weeks (11-48 weeks). Two patients (4.3%) underwent revision surgery for non-union and there was no implant failure. Thirty-seven (80.4%) patients achieved their pre-fracture ambulatory function at the final follow up.
  
  
  CONCLUSIONS
  Although the incidence of delayed bone healing is high in atypical femoral fracture on bisphosphonate therapy even treated with intramedullary nailing, the incidence of revision surgery and implant failure was relatively lower than those of extramedullary devices.
authors.affiliation: Department of Orthopaedic Surgery, Keimyung University Dongsan Medical Center, Daegu, South Korea. Electronic address: oslee@dsmc.or.kr.
authors.forename: Kyung-Jae
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea. Electronic address: jjyos@snu.ac.kr.
authors.forename: Jeong Joon
authors.initials: JJ
authors.lastname: Yoo
authors.affiliation: Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea. Electronic address: damioh@gmail.com.
authors.forename: Kwang-Jun
authors.initials: KJ
authors.lastname: Oh
authors.affiliation: Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, South Korea. Electronic address: oships@hallym.ac.kr.
authors.forename: Je-Hyun
authors.initials: JH
authors.lastname: Yoo
authors.affiliation: Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, South Korea. Electronic address: khrhyu@empas.com.
authors.forename: Kee Hyung
authors.initials: KH
authors.lastname: Rhyu
authors.affiliation: Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea. Electronic address: kingkangu@gmail.com.
authors.forename: Kwang Woo
authors.initials: KW
authors.lastname: Nam
authors.affiliation: Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, South Korea. Electronic address: mayhap@hanmail.net.
authors.forename: Dong-Hoon
authors.initials: DH
authors.lastname: Suh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001858:Bone Nails; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D005598:Fractures, Spontaneous / Q000139:chemically induced / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Atypical femoral fracture; Bisphosphonate; Intramedullary nailing; Union