Description
The presentation, led by Tim White, focuses on atypical femoral fractures, posing a challenging question: "Do we know what we are doing?" It highlights the uncertainties and complexities involved in treating these fractures. Atypical femoral fractures are rare, constituting only about 1% of all femoral fractures, and typically arise from minimal trauma, often preceded by discomfort in the hip or thigh. Their radiographic characteristics include a transverse element on the lateral cortex with signs of sclerosis and beaking, and they can appear bilaterally in 40% of patients. The talk further explores the connection between these fractures and long-term bisphosphonate use but clarifies that they can also occur in individuals who have never been administered these medications.
The American Society for Bone and Mineral Research has established guidelines for identifying atypical femoral fractures, emphasizing the need for meticulous diagnosis. The speaker discusses the biomechanical and biological factors contributing to these fractures, including the impact of bisphosphonates on bone density and healing. Data presented indicate a correlation between the duration of bisphosphonate therapy and the incidence of fractures, highlighting a paradox where the treatment intended to prevent fractures may also contribute to the risk of atypical ones.
Management strategies for these fractures start with diagnosis, typically confirmed with plain X-rays, and may involve prophylactic nailing for symptomatic incomplete fractures. The discussion continues into the surgical management of complete fractures, emphasizing the need for precise anatomical reduction to avoid complications such as delayed union, malunion, and a higher likelihood of reoperation. The prognosis may be improved with treatments like teriparatide, particularly in complex cases.
Case studies illustrate the importance of early intervention and proper surgical techniques in managing these challenging fractures, while also reminding medical professionals to maintain a high suspicion for possible bilateral injuries in patients presenting with hip pain.