Shim BJ, Won H, Kim SY, Baek SH. Surgical strategy of the treatment of atypical femoral fractures. World J Orthop 2023; 14(5): 302-311 [PMID: 37304202 DOI: 10.5312/wjo.v14.i5.302]
Corresponding Author of This Article
Seung-Hoon Baek, MD, PhD, Professor, Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University, College of Medincine, 130, Dongdeok-ro, Jung-Gu, Daegu 41944, South Korea. insideme@paran.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. May 18, 2023; 14(5): 302-311 Published online May 18, 2023. doi: 10.5312/wjo.v14.i5.302
Surgical strategy of the treatment of atypical femoral fractures
Bum-Jin Shim, Heejae Won, Shin-Yoon Kim, Seung-Hoon Baek
Bum-Jin Shim, Heejae Won, Department of Orthopedic Surgery, Kyungpook National University Chilgok Hospital, Daegu 41404, South Korea
Bum-Jin Shim, Department of Orthopedic Surgery, Kyungpook National University, College of Medincine, Daegu 41944, South Korea
Shin-Yoon Kim, Seung-Hoon Baek, Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University, College of Medincine, Daegu 41944, South Korea
Author contributions: Shim BJ performed the majority of the writing, prepared the figures and tables; Won H provided the input in writing the paper; Kim SY performed data accusation and writing; Baek SH designed the outline and coordinated the writing of the paper.
Supported byKorean Fund for Regenerative Medicine (KFRM) grant funded by the Korea Government (the Ministry of Science and ICT, the Ministry of Health & Welfare), No. 22D0801L1 and No. 22C0604L1.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Seung-Hoon Baek, MD, PhD, Professor, Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University, College of Medincine, 130, Dongdeok-ro, Jung-Gu, Daegu 41944, South Korea. insideme@paran.com
Received: December 13, 2022 Peer-review started: December 13, 2022 First decision: February 8, 2023 Revised: February 16, 2023 Accepted: April 19, 2023 Article in press: April 19, 2023 Published online: May 18, 2023
Abstract
The atypical femoral fracture (AFF) has been attracting significant attention because of its increasing incidence; additionally, its treatment is challenging from biological and mechanical aspects. Although surgery is often required to manage complete AFFs, clear guidelines for the surgical treatment of AFFs are currently sparse. We reviewed and described the surgical treatment of AFFs and the surveillance of the contralateral femur. For complete AFFs, cephalomedullary intramedullary nailing spanning the entire length of the femur can be used. Various surgical techniques to overcome the femoral bowing common in AFFs include a lateral entry point, external rotation of the nail, and the use of a nail with a small radius of curvature, or a contralateral nail. In the case of a narrow medullary canal, severe femoral bowing, or pre-existing implants, plate fixation may be considered as an alternative. For incomplete AFFs, prophylactic fixation depends on several risk factors, such as a subtrochanteric location, presence of a radiolucent line, functional pain, and condition of the contralateral femur; the same surgical principles as those in complete AFFs can be applied. Finally, once AFF is diagnosed, clinicians should recognize the increased risk of contralateral AFFs, and close surveillance of the contralateral femur is recommended.
Core Tip: For complete atypical femoral fractures (AFFs), cephalomedullary intramedullary nailing spanning the entire femur and various surgical techniques to overcome femoral bowing should be considered. For incomplete AFFs, the recognition of impending complete fractures is important. For the contralateral femur, close surveillance is recommended because of the increased risk of contralateral AFF.
