Surgical strategy of the treatment of atypical femoral fractures

Figure 1 Images of an 80-year-old woman. A: An 80-year-old woman was transferred from a spine clinic because of intractable right thigh pain for three months. Radiographs revealed a transverse radiolucent line (white arrows and insets) on the lateral and anterior cortex of the right femur with 10° of varus. The patient refused prophylactic surgery for incomplete atypical femoral fracture (AFF); however, medical treatment including a switch from bisphosphonate to teriparatide was initiated. According to a scoring system[11], the risk for impending complete AFF was scored as 10 points; B: Two months later, she visited the emergency department due to progression to a complete AFF; C: She underwent fixation with a long cephalomedullary nail (Trochanteric Fixation Nail-Advanced^®, DePuy Synthes, Winterthur, Switzerland) spanning the whole length of the femur. It is to be noted that the entry point of the nail is lateral and anterior to the greater trochanter tip (arrowheads); D: Radiographs taken at 18 mo postoperatively showed healing of the fracture site.