J Korean Orthop Assoc.  2024 Feb;59(1):9-14. 10.4055/jkoa.2024.59.1.9 .

How to Improve Fracture Healing in Atypical Femoral Fractures

• Jeong SJ
• Park CW
• Lim SJ

• KMID: 2553343
• DOI: http://doi.org/10.4055/jkoa.2024.59.1.9

Abstract

The increased incidence of atypical femoral fractures (AFFs) appears to be related to an aging population and a consequent increase in bisphosphonate use. In patients with AFF, the bone healing potential for fracture union is generally suppressed, and the surgical techniques for internal fixation are often challenging. Therefore, complications, such as fixation failure, delayed union, and nonunion, are frequently reported. Prompt discontinuation of bone resorption inhibitors, including bisphosphonates, is fundamental to the successful treatment of AFF. In addition, calcium and vitamin D should be supplemented, and known risk factors for nonunion should be excluded. Intramedullary nailing is considered the treatment of choice in the surgical management of AFF. During surgery, anatomical reduction and the firm internal fixation of fracture fragments are required while preserving the surrounding soft tissue. There are reports on the benefits of postoperative parathyroid hormone administration in fracture healing, but more evidence is needed.

Keyword

atypical femoral fracture; bisphosphonates; teriparatide; osteoporosis; intramedullary nail