Outcomes for Elderly Patients With Atypical Femoral Fractures Compared to Typical Femoral Fractures for Length of Stay, Discharge Destination, and 30-Day Mortality Rate

Abstract

Introduction:Despite increasing recognition of atypical femoral fractures (AFFs), there’s conflicting evidence about incidence, aetiology, and short-term outcomes of these injuries. This study reports the incidence of AFFs at our center and compares the early postoperative outcomes against typical femoral fractures (TFFs).Methods:A retrospective observational cohort study of patients presenting to our trauma unit between November 2015 and July 2016 was undertaken. Inclusion criteria required radiologically confirmed proximal femoral fracture, which was then categorized as AFF or TFF. Primary outcome measures included length of stay, discharge destination, and 30-day mortality.Results:Two hundred thirty-nine patients presented to our trauma unit over 9 months with either a fractured neck of femur or proximal femoral fracture. A total of 122 were identified as pertrochanteric, subtrochanteric, or proximal femoral shaft fractures of which 25 (20.5%) displayed atypical radiographic features consistent with AFF. The 2 groups were similar for average age (TFF 85.3 years vs AFF 85.0 years), gender (19% vs 16% male gender), American Society of Anaesthesiology grade (3.0 vs 3.0), cognitive score (abbreviated mental test score = 7.03 vs 7.08), and preinjury place of residence (88.9% vs 92.0% lived in own home). Typical fractures were fixed with either dynamic hip screw or intramedullary nailing, all atypical fractures were fixed with intramedullary nailing. There was no statistical difference between the 2 groups for length of stay (12.8 days vs 14.3 days; P > .05), discharge to preinjury residence (45.1% vs 36%; P > .05), or 30-day mortality (8.1% vs 12%; P > .05).Discussion:In our predominantly geriatric population atypical radiographic features were observed in around 10% of patients presenting with proximal femoral fractures or fractured neck of femur. Previous studies have reported poor outcomes for pain, mobility, and length of stay after AFF. However, we observed no difference in short-term outcome measures when compared to patients with typical proximal femoral fracture patterns at our trauma unit.Conclusion:With modern principles of trauma care outcomes achieved following AFFs may be equivalent to typical femoral fractures in the geriatric population.

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

“…This enabled rapid optimisation of fitness for surgery, early identification of rehabilitation goals and a return to pre-injury mobility and function. Our mean length of stay was 8.2 days, which is in contrast to 12.5 days, as reported by Davenport et al 20…”

“…This enabled rapid optimisation of fitness for surgery, early identification of rehabilitation goals and a return to pre-injury mobility and function. Our mean length of stay was 8.2 days, which is in contrast to 12.5 days, as reported by Davenport et al 20 All patients had radiographs taken of their contralateral femurs to assess for bilateral disease. Four patients were found to have periosteal thickening and beaking of their lateral femoral cortices with the risk of impending fracture.…”

Incidence of Atypical Femoral Fracture and Its Mortality in a Single Center in Singapore

“…Although increased mortality associated with typical fragility fractures of the femur is known 10,11 , the rate of death associated with AFF has not been well established. A previous study in Sweden found lower mortality in AFF compared to ordinary fractures 12 , another study in an elderly population in UK found no difference in mortality at 30 days 13 . No previous studies in the South East Asian population have been performed.…”

“…A previous study in Sweden found lower mortality in patients with AFF in follow up duration of a mean of 4 years 12 . Another study found no differences in mortality in a 30 day follow up 29 . When we compared the mortality rates of patients with AFF and typical subtrochanteric femoral fractures to the national standardized age mortality rate in the population in chronological 5 year increment, we found that mortality risk for AFF patients were lower compared to the aged standardized mortality in the general population, however patients with typical fracture remains at a higher mortality risk compared to general population.…”

“…A previous study in Sweden found lower mortality in AFF compared with ordinary fractures, (12) whereas another study in an elderly population in UK found no difference in mortality at 30 days. (13) No previous studies in the Southeast Asian population have been performed. Given the likely higher risk of AFF in this population, we set out to study the incidence of AFF in our Southeast Asian population and its related demographic and clinical risk factors.…”