Management of atypical femoral fractures

Abstract

Atypical femoral fractures are characterized by a lateral stress-mitrated reaction, a transverse fracture line, and medial beaking. These fractures occur as a small percentage of hip and femur fracture. Prior prolonged bisphosphonate treatment is most common, usually greater than 5 years. There is a high likelihood of bilateral fractures in approaching 50 %. MRI edema and bone scan activity are usually present. The key elements of treatment initiate with diagnostic imaging to determine location and activity. All patients should cease bisphosphonates and switch to anabolic agents such as PTH 1-34 as well as correct calcium and Vitamin D. Complete fractures are best treated by intramedullary nailing or compression plating requiring ORIF if a fracture line is present. Simple stress reaction without a cortical defect may respond to medical management.