Saleh et al outlined the management of a patient with an atypical femoral fracture that may be associated with bisphosphonate therapy.
Initial steps:
(1) Start vitamin D and calcium supplementation.
(2) Stop bisphosphonate therapy.
(3) Take radiographs of both femurs (due to frequency of bilateral disease).
Parameters:
(1) type of atypical femoral fracture
(2) radiolucent fracture line
(3) bone marrow edema on MRI
(4) response to conservative therapy (partial weight-bearing, consider teriparatide)
|
Type of Fracture |
Radiolucent Fracture Line |
Bone Marrow Edema |
Conservative Therapy |
Management Plan |
|
complete |
NA |
NA |
NA |
1 |
|
incomplete |
Y |
NA |
NA |
2 |
|
incomplete |
N |
N |
NA |
3 |
|
incomplete |
N |
Y |
improve |
3 |
|
incomplete |
N |
Y |
worsen |
2 |
where:
• The desired outcome of conservative therapy is (1) resolution of pain and (2) resolution of bone marrow edema in follow-up MRI.
|
Plan |
Details |
|
1 |
intramedullary nails if possible; plates may be necessary if reduction difficult or cortex thickened; may require revision with autologous bone graft |
|
2 |
surgical prophylaxis |
|
3 |
observe |
Specialty: Surgery, orthopedic, Pharmacology, clinical
