Hip Pelvis.  2018 Dec;30(4):202-209. 10.5371/hp.2018.30.4.202.

Surgical Treatment of the Atypical Femoral Fracture: Overcoming Femoral Bowing

• Lee KJ
• Min BW

• KMID: 2427923
• DOI: http://doi.org/10.5371/hp.2018.30.4.202

Abstract

Atypical femoral fractures differ from ordinary femoral diaphyseal or subtrochanteric fractures in several aspects. Although several authors have reported the results of surgical treatment for atypical femoral fractures, the rate of complications (e.g., delayed union, nonunion, fixation failure, and reoperation) is still high. Therefore, we reviewed principles of surgical treatment and describe useful methods for overcoming femoral bowing in these high-risk patients.

Keyword

Atypical femoral fracture; Surgical treatment; Femoral bowing

MeSH Terms

Femoral Fractures*
Hip Fractures
Humans

Figure

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  Fig. 1 Anteroposterior (A) and lateral (B) radiographs of the left femur showing the common characteristics of atypical femoral fractures. 1, Transverse or short oblique fracture line; 2, noncomminuted or minimally comminuted; 3, localized periosteal or endosteal thickening of the lateral cortex; and 4, medial spike.

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  Fig. 2 Anteroposterior radiographs of subtrochanteric atypical femoral fracture. (A) Preoperative; (B) open reduction and internal fixation with extramedullary device was performed; and (C) fixation failure developed after 4 postoperative months.

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  Fig. 3 (A, B) Plating may be performed when a nail cannot be used, such as with an extremely narrow intramedullary canal (circle).

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  Fig. 4 An illustration revealing the treatment algorithm of atypical femoral fractures. WB: weight bearing.

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  Fig. 5 Anteroposterior radiograph of the right femur (A) after intramedullary nailing reveals straightening of the femur compared with the curved left femur (B).

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  Fig. 6 Anteroposterior radiographs of pre-operation (A) and post-operation (B) reveal the iatrogenic fracture (arrow) due to mismatch between femoral bowing and intramedullary nail.

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  Fig. 7 (A) Radiographs of both femurs showing right diaphyseal atypical femoral fracture and a bowed left femur. (B) Postoperative radiograph revealing the far lateral entry point of the standard interlocking nail. (C) Radiograph obtained 4 months after surgery showing progression of union.

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  Fig. 8 (A) Radiographs of both femurs showing left diaphyseal atypical femoral fracture and bowed right femur. (B) Intramedullary nail on the opposite (right) side was used for overcoming the mismatch.

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  Fig. 9 External rotation of the ipsilateral nail for femoral bowing.

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  Fig. 10 Preoperative (A) and postoperative (B) anteroposterior radiographs demonstrating the use of the ipsilateral nail with external rotation. (C) During nail insertion, the nail is externally rotated when the tip reaches the apex of the femur.

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  Fig. 11 (A, B) Whole femur plating for the peri-implant atypical fracture. (C) Minimally invasive plate osteosynthesis was used.

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