Increased rate of reoperation in atypical femoral fractures is related to patient characteristics and not fracture type. A nationwide cohort study

Abstract

Atypical femoral fractures are burdened with a high rate of reoperation. In our nationwide analysis, the increased rate of reoperation was related to patient background characteristics, such as age and health status, rather than fracture type. Introduction Patients with atypical fractures are complex to treat and burdened with a high risk of reoperation. We hypothesized that patients with surgically treated, complete atypical fractures have a higher risk of any reoperation and reoperation related to healing complications than patients with common femoral shaft fractures but that this increase would become insignificant when adjusted for predefined characteristics. Methods A cohort of 163 patients with atypical fractures and 862 patients with common femoral shaft or subtrochanteric fractures treated from 2008 to 2010 and who had follow-up radiographs and register data available until 31 December 2014 was included. Reoperations were identified by a complementary review of radiographs and register data and were used to calculate risks for any reoperation and reoperations related to healing complications. Results Patients with atypical fractures were more likely to be reoperated for any reason, age-adjusted OR 1.76 (95% CI, 1.08 to 2.86). However, patients with common fractures had a shorter follow-up due to a threefold higher death rate. Accordingly, in a multivariable-adjusted time-to-event model, the increased risk lost statistical significance for any reoperations, cause-specific HR 1.34 (95% CI, 0.85 to 2.13), and for reoperations related to healing complications, HR 1.32 (95% CI, 0.58 to 3.0). Continued use of bisphosphonate in the first year after the fracture did not affect the reoperation rate. Conclusions Our findings suggest that the increased risk of reoperation after an atypical femur fracture is largely explained by patient characteristics and not fracture type.

Bisphosphonate-related atypical femoral fractures: A novel strategy to improve patient outcomes

“…14,15 It is well described that patients with AFF experience greater stress concentration over a longer period of time due to slow healing, leading to delayed union and implant failure. 16 To reduce excessive micromotion at the fracture site and maximise fixation rigidity, we opted to always utilise two static distal interlocking locking bolts through the cephalomedullary nail.…”

Surveillance of atypical femoral fractures in a nationwide fracture register

“…The personal identification number was used to retrieve all the radiographs of the ipsilateral femur for each patient from the relevant radiology department and stored in the PACS at Linköping University Hospital, Sweden. To provide a control group of patients with normal femur fractures, we randomly selected an additional 176 patients from our previous study cohort with normal femoral fractures (NFFs) from 2008 to 2010 ( 8 ) (mean age, 82 years; SD 9.6; 80% females in the initial study cohort), to form the current study cohort ( Figure 2 ). Radiographs from these patients served as a negative control population to derive the gold-standard classification and the educated-user classification described below.…”

“…The year 2018 was chosen because the extent of coverage of the register is steadily increasing and 2018 was the most recent year with complete register data at the time of data extraction. We used a well-defined, nationwide cohort of patients with AFF for the period 2008–2010 as a reference population ( 8 ), to extrapolate the expected incidence rate of AFF in the whole population of women and men aged > 55 years in 2018 (Table), using population data from Statistics Sweden ( https://www.scb.se/en/ ; the governmental agency for official statistics in Sweden).…”

Deep neural networks with promising diagnostic accuracy for the classification of atypical femoral fractures

“…Early and correct diagnosis of AFF is essential for appropriate management (Bogl et al 2020a), which minimizes the risk of healing complications (Bogl et al 2020b). In clinical routine practice, conventional radiographs are used to diagnose complete AFF.…”

“…Early and correct diagnosis of AFF is essential for appropriate management (Bogl et al. 2020a ), which minimizes the risk of healing complications (Bogl et al. 2020b ).…”