Factors Affecting the Second Complete Atypical Femoral Fracture after the First Atypical Fracture.

IF 2.9 3区医学 Q1 MEDICINE, GENERAL & INTERNAL Medical Principles and Practice Pub Date : 2024-01-01 Epub Date: 2023-12-15 DOI:10.1159/000535759

Hiroyuki Tsuchie, Yuji Kasukawa, Koji Nozaka, Hayato Kinoshita, Ken Sasaki, Toshiaki Aizawa, Motoki Mita, Kentaro Ouchi, Yusuke Yuasa, Takanori Miura, Takenori Tomite, Shigeto Maekawa, Hidekazu Abe, Manabu Akagawa, Nobusuke Shibata, Masashi Fujii, Masaaki Takeshima, Jyunichi Inoue, Hikaru Saito, Naohisa Miyakoshi

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Abstract

Objectives: Atypical femoral fracture (AFF) is an atypical low-energy subtrochanteric and diaphyseal femoral fracture. Even if bone fusion is achieved in patients with AFF, the risk of AFF in the contralateral femur must be considered. This study aimed to investigate the factors affecting complete AFF in the contralateral femur and conservatively treated incomplete AFF.

Subject and methods: Radiographs of 111 femurs in 104 AFF cases were examined, and the femurs were classified as follows: 85 contralateral femurs with complete AFF; 18 contralateral femurs with incomplete AFF; 8 femurs with incomplete AFF without surgical treatment. Various patients' clinical data were collected, and we investigated the factors affecting the second complete AFF.

Results: Complete fractures occurred in 10 (9.7%) of 103 femurs without incomplete AFF at the first visit and in 3 (37.5%) of 8 femurs with incomplete AFF. The Kaplan-Meier curve revealed that lateral cortical bone thickening and thigh pain were associated with significantly poorer prognoses (p = 0.026 and p = 0.013, respectively). Multivariate analyses revealed that eldecalcitol usage after AFF onset (p = 0.0094) and previous use of bisphosphonate or denosumab (p = 0.0126) were protective factors for second complete AFF and that the presence of thigh pain (p = 0.0134) was a risk factor for second complete AFF.

Conclusions: Eldecalcitol administration after bone union of first AFF may prevent AFF recurrence. In addition, painful incomplete AFF has a high risk of developing a complete fracture.

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影响第一次非典型骨折后第二次完全性非典型股骨骨折的因素。

目的：非典型股骨骨折（AFF）是一种非典型的低能量股骨转子下和骨骺骨折。即使 AFF 患者实现了骨融合，也必须考虑对侧股骨发生 AFF 的风险。本研究旨在探讨影响对侧股骨完全AFF和保守治疗不完全AFF的因素：对104例AFF患者的111个股骨的X光片进行检查，并将股骨分为以下几类：85个对侧股骨完全AFF；85个对侧股骨不完全AFF；85个对侧股骨不完全AFF：对侧股骨完全AFF 85例；对侧股骨不完全AFF 18例；未手术治疗的不完全AFF 8例。我们收集了患者的各种临床数据，并研究了影响第二次完全AFF的因素：在首次就诊的 103 例未进行不完全 AFF 的股骨中，有 10 例（9.7%）发生了完全骨折；在 8 例进行了不完全 AFF 的股骨中，有 3 例（37.5%）发生了完全骨折。卡普兰-梅耶曲线显示，外侧皮质骨增厚和大腿疼痛与较差的预后明显相关（p=0.026 和 p=0.013）。多变量分析显示，AFF发生后使用艾地卡骨化醇（p=0.0094）和既往使用过双磷酸盐或地诺单抗（p=0.0126）是第二次完全AFF的保护因素，而出现大腿疼痛（p=0.0134）是第二次完全AFF的危险因素：结论：在第一次AFF骨结合后服用艾地卡糖醇可预防AFF复发。此外，疼痛的不完全 AFF 发生完全骨折的风险很高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Medical Principles and Practice 医学-医学：内科

CiteScore

6.10

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： ''Medical Principles and Practice'', as the journal of the Health Sciences Centre, Kuwait University, aims to be a publication of international repute that will be a medium for dissemination and exchange of scientific knowledge in the health sciences.