Atypical periprosthetic femoral fractures of the hip: characterisation of three cases

Abstract

Introduction: Long-term use of bisphosphonates (BPs) has been associated with a specific type of tensile side femoral stress fracture known as Atypical Femoral Fracture (AFF). Theoretically periprosthetic femoral fractures (PFF) should be excluded from the diagnosis of AFF. However, emerging evidence correlates prolonged BPs use with the occurrence of a type of PFF with an atypical pattern (atypical PFF, APFF). The aim of the present study is to report 3 cases of APFF treated at a single centre. Methods: Clinical and radiographic records of PFF that occurred between January 2016 and August 2018 were retrospectively reviewed. All patients meeting the American Society for Bone and Mineral Research (ASBMR) criteria for definition of PFF were included. Management strategies for APFF and patient outcomes, including fracture healing and hip function (assessed by the Oxford Hip Score [OHS]) were collected. Results: 3 patients in the study period were identified as APFF (1 incomplete, 2 complete). All patients were females with a mean age of 83.3 years. All patients were treated with lateral plating. The application of a contralateral strut allograft resulted in fracture healing in cases of complete fractures. Mean OHS at final follow-up was 34.3. Conclusions: Despite occurring around a hip stem like PFF, APFF had peculiar clinical and radiographic features, making them more similar to AFF. Therefore, the orthopaedic surgeon should also consider the natural history and healing problems associated with AFF prior in order to choose the most appropriate management for APFF.

Extracapsular femoral neck fractures treated with total hip arthroplasty: identification of a population with better outcomes

“…For example, patients with FNF (as well as those with periprosthetic ones), are more fragile than those with primary HO, presenting more comorbidities and a more severe osteoporosis. 15,39 The reason why in our study patient's age has a such impact on hip function is unclear. It could be assumed that patients with less than 75 years of age presented both a better mobility, and general health status prior the FNF; and these factors might improve their recoverability.…”

Surgical and Pharmacological Management of Periprosthetic Atypical Femoral Fractures: A Narrative Literature Review

“…However, there are a number of published studies suggesting that periprosthetic atypical femoral fractures (PAFFs) can occur and should not be excluded by definition. 18 - 42 Subsequently, PAFFs could be considered as a subset of PFFs that present AFFs’ features. 21 , 36 Unfortunately, the lack of data available on this topic does not allow the development of precise diagnostic criteria to identify PAFFs in order to avoid misdiagnosis.…”

“…It is thought that administration of Teriparatide is associated with an increase in osteoblast number and activity, which results in an increased bone remodeling rate and trabecular thickness and connectivity. 34 , 75 , 76 Vitamin D levels should be maintained above 30 ng/mL, 77 or whatever level is necessary to assure a normal PTH level as chronically elevated PTH will deplete bone stores.…”