Update on Atypical Femoral Fractures.
| Autor: | Anderson PA; Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin., Kates SL; Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia., Watts ND; Osteoporosis and Bone Health Services, Mercy Health, Cincinnati, Ohio. |
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| Jazyk: | angličtina |
| Zdroj: | The Journal of bone and joint surgery. American volume [J Bone Joint Surg Am] 2024 Aug 22. Date of Electronic Publication: 2024 Aug 22. |
| DOI: | 10.2106/JBJS.23.01439 |
| Abstrakt: | ➤ Atypical femoral fractures (AFFs) are stress fractures between the lesser trochanter and the metaphyseal flare that are most commonly related to prolonged (3 to 5 years) antiresorptive medication use.➤ An important finding is a visible transverse line in the lateral cortex, known as the "dreaded black line." Complete fractures are transverse and have minimal comminution.➤ Prodromal symptoms including hip, groin, thigh, and knee pain are present in more than one-half of cases and are usually misdiagnosed.➤ Nonoperative treatment for all patients with AFF includes withdrawal of bisphosphonates, assessment for secondary causes of osteoporosis, and optimization of vitamin D and calcium.➤ Incomplete fractures without a visible line can initially be treated nonoperatively with protected weight-bearing.➤ Intramedullary nailing is indicated for complete fractures and incomplete fractures with a visible fracture line. Delayed healing after fixation should be anticipated.➤ Treatment with parathyroid hormone (PTH) analogs (teriparatide and abaloparatide) after AFF prevents other fractures in high-risk patients, but the effect on healing of the fracture is unclear. Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/I164). (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.) |
| Databáze: | MEDLINE |
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