Surgical strategy of the treatment of atypical femoral fractures

Figure 3 Images of a 75-year-old woman underwent a fixation with a long standard nail. A: A 75-year-old woman underwent a fixation with a long standard nail due to a complete atypical femoral fracture (AFF) on her right femur two years ago at another hospital and kept taking bisphosphonate (BP) until she visited our clinic; B: She reported left groin and thigh pain for six months. Radiographs revealed arthritis on her left hip joint (arrowheads) and transverse beaks with radiolucent lines (“dreaded black line”) on the lateral and anterior cortex of the left femur (white arrows and insets). According to a scoring system[11], the risk for impending complete AFF was scored as 8 points and BP medication was discontinued; C: Before total hip arthroplasty (THA) to treat hip arthritis, a locking compression plate was pre-contoured along the shape of the bone model with 3D printing rapid prototyping; D: During THA, the sterile 3D-printed model was placed in the same position as that of the femur and used as a surgical navigation. Fixation with the pre-contoured plate via minimally invasive plate osteosynthesis was performed to treat incomplete AFF; E: Radiographs taken three years postoperatively showed complete healing of the AFF without progression of femoral bowing or implant-related complications.