Healing Time and Complications in Operatively Treated Atypical Femur Fractures Associated With Bisphosphonate Use: A Multicenter Retrospective Cohort

Yelena Bogdan, Paul Tornetta, Thomas A. Einhorn, Pierre Guy, Lise Leveille, Juan Robinson, Michael J. Bosse, Nikkole Haines, Daniel Horwitz, Clifford Jones, Emil Schemitsch, Claude Sagi, Bryan Thomas, Daniel Stahl, William Ricci, Megan Brady, David Sanders, Michael Kain, Thomas F F Higgins, Cory CollingeStephen Kottmeier, Darin Friess

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

OBJECTIVES:: The purpose of this study is to characterize demographics, healing time and complications of a large series of operatively treated atypical femur fractures. DESIGN:: Retrospective multicenter review. SETTING:: 17 academic medical centers. PATIENTS:: Bisphosphonate related fractures as defined by ASBMR. Fractures had to be followed for at least 6 months or to union or revision. INTERVENTION:: Operative treatment of bisphosphonate related fracture. MAIN OUTCOME MEASUREMENTS:: Union time and complications of treatment, as well as information about the contralateral limb. RESULTS:: There were 179 patients, average age 72, average BMI 27.2. Average followup was 17 months. Twenty-one percent had a prior history of fragility fracture; 34% had prodromal pain. Most (88%) lived independently before injury. Thirty-one percent had radiographic changes suggesting stress reaction. Surgical fixation was with cephalomedullary nail (51%), IM nail (48%) or plate (1%). Complications included death (4), PE (3), and wound infection (6). Twenty (12%) patients underwent revision at an average of 11 months. Excluding revisions, average union time was 5.2 months. For revisions, union occurred at an average of 10.2 months after intervention. No association was identified between discontinuation of bisphosphonates and union time (P =0.5) or need for revision (P =0.7). Twenty-one percent sustained contralateral femur fractures; 32% of these had pain and 59% had stress reaction prior to contralateral fracture. CONCLUSIONS:: In this series, surgery had a 12% failure rate and delayed average time to union. Twenty-one percent developed contralateral femur fractures within 2 years, underscoring the need to evaluate the contralateral extremity. LEVEL OF EVIDENCE:: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
JournalJournal of Orthopaedic Trauma
DOIs
StateAccepted/In press - Dec 19 2015

Fingerprint

Diphosphonates
Femur
Nails
Extremities
Pain
Wound Infection
Therapeutics
Demography
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Healing Time and Complications in Operatively Treated Atypical Femur Fractures Associated With Bisphosphonate Use : A Multicenter Retrospective Cohort. / Bogdan, Yelena; Tornetta, Paul; Einhorn, Thomas A.; Guy, Pierre; Leveille, Lise; Robinson, Juan; Bosse, Michael J.; Haines, Nikkole; Horwitz, Daniel; Jones, Clifford; Schemitsch, Emil; Sagi, Claude; Thomas, Bryan; Stahl, Daniel; Ricci, William; Brady, Megan; Sanders, David; Kain, Michael; Higgins, Thomas F F; Collinge, Cory; Kottmeier, Stephen; Friess, Darin.

In: Journal of Orthopaedic Trauma, 19.12.2015.

Research output: Contribution to journalArticle

Bogdan, Y, Tornetta, P, Einhorn, TA, Guy, P, Leveille, L, Robinson, J, Bosse, MJ, Haines, N, Horwitz, D, Jones, C, Schemitsch, E, Sagi, C, Thomas, B, Stahl, D, Ricci, W, Brady, M, Sanders, D, Kain, M, Higgins, TFF, Collinge, C, Kottmeier, S & Friess, D 2015, 'Healing Time and Complications in Operatively Treated Atypical Femur Fractures Associated With Bisphosphonate Use: A Multicenter Retrospective Cohort', Journal of Orthopaedic Trauma. https://doi.org/10.1097/BOT.0000000000000516
Bogdan, Yelena ; Tornetta, Paul ; Einhorn, Thomas A. ; Guy, Pierre ; Leveille, Lise ; Robinson, Juan ; Bosse, Michael J. ; Haines, Nikkole ; Horwitz, Daniel ; Jones, Clifford ; Schemitsch, Emil ; Sagi, Claude ; Thomas, Bryan ; Stahl, Daniel ; Ricci, William ; Brady, Megan ; Sanders, David ; Kain, Michael ; Higgins, Thomas F F ; Collinge, Cory ; Kottmeier, Stephen ; Friess, Darin. / Healing Time and Complications in Operatively Treated Atypical Femur Fractures Associated With Bisphosphonate Use : A Multicenter Retrospective Cohort. In: Journal of Orthopaedic Trauma. 2015.
@article{7779e68c44604d9c882f52de216fb0e5,
title = "Healing Time and Complications in Operatively Treated Atypical Femur Fractures Associated With Bisphosphonate Use: A Multicenter Retrospective Cohort",
abstract = "OBJECTIVES:: The purpose of this study is to characterize demographics, healing time and complications of a large series of operatively treated atypical femur fractures. DESIGN:: Retrospective multicenter review. SETTING:: 17 academic medical centers. PATIENTS:: Bisphosphonate related fractures as defined by ASBMR. Fractures had to be followed for at least 6 months or to union or revision. INTERVENTION:: Operative treatment of bisphosphonate related fracture. MAIN OUTCOME MEASUREMENTS:: Union time and complications of treatment, as well as information about the contralateral limb. RESULTS:: There were 179 patients, average age 72, average BMI 27.2. Average followup was 17 months. Twenty-one percent had a prior history of fragility fracture; 34{\%} had prodromal pain. Most (88{\%}) lived independently before injury. Thirty-one percent had radiographic changes suggesting stress reaction. Surgical fixation was with cephalomedullary nail (51{\%}), IM nail (48{\%}) or plate (1{\%}). Complications included death (4), PE (3), and wound infection (6). Twenty (12{\%}) patients underwent revision at an average of 11 months. Excluding revisions, average union time was 5.2 months. For revisions, union occurred at an average of 10.2 months after intervention. No association was identified between discontinuation of bisphosphonates and union time (P =0.5) or need for revision (P =0.7). Twenty-one percent sustained contralateral femur fractures; 32{\%} of these had pain and 59{\%} had stress reaction prior to contralateral fracture. CONCLUSIONS:: In this series, surgery had a 12{\%} failure rate and delayed average time to union. Twenty-one percent developed contralateral femur fractures within 2 years, underscoring the need to evaluate the contralateral extremity. LEVEL OF EVIDENCE:: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.",
author = "Yelena Bogdan and Paul Tornetta and Einhorn, {Thomas A.} and Pierre Guy and Lise Leveille and Juan Robinson and Bosse, {Michael J.} and Nikkole Haines and Daniel Horwitz and Clifford Jones and Emil Schemitsch and Claude Sagi and Bryan Thomas and Daniel Stahl and William Ricci and Megan Brady and David Sanders and Michael Kain and Higgins, {Thomas F F} and Cory Collinge and Stephen Kottmeier and Darin Friess",
year = "2015",
month = "12",
day = "19",
doi = "10.1097/BOT.0000000000000516",
language = "English (US)",
journal = "Journal of Orthopaedic Trauma",
issn = "0890-5339",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Healing Time and Complications in Operatively Treated Atypical Femur Fractures Associated With Bisphosphonate Use

T2 - A Multicenter Retrospective Cohort

AU - Bogdan, Yelena

AU - Tornetta, Paul

AU - Einhorn, Thomas A.

AU - Guy, Pierre

AU - Leveille, Lise

AU - Robinson, Juan

AU - Bosse, Michael J.

AU - Haines, Nikkole

AU - Horwitz, Daniel

AU - Jones, Clifford

AU - Schemitsch, Emil

AU - Sagi, Claude

AU - Thomas, Bryan

AU - Stahl, Daniel

AU - Ricci, William

AU - Brady, Megan

AU - Sanders, David

AU - Kain, Michael

AU - Higgins, Thomas F F

AU - Collinge, Cory

AU - Kottmeier, Stephen

AU - Friess, Darin

PY - 2015/12/19

Y1 - 2015/12/19

N2 - OBJECTIVES:: The purpose of this study is to characterize demographics, healing time and complications of a large series of operatively treated atypical femur fractures. DESIGN:: Retrospective multicenter review. SETTING:: 17 academic medical centers. PATIENTS:: Bisphosphonate related fractures as defined by ASBMR. Fractures had to be followed for at least 6 months or to union or revision. INTERVENTION:: Operative treatment of bisphosphonate related fracture. MAIN OUTCOME MEASUREMENTS:: Union time and complications of treatment, as well as information about the contralateral limb. RESULTS:: There were 179 patients, average age 72, average BMI 27.2. Average followup was 17 months. Twenty-one percent had a prior history of fragility fracture; 34% had prodromal pain. Most (88%) lived independently before injury. Thirty-one percent had radiographic changes suggesting stress reaction. Surgical fixation was with cephalomedullary nail (51%), IM nail (48%) or plate (1%). Complications included death (4), PE (3), and wound infection (6). Twenty (12%) patients underwent revision at an average of 11 months. Excluding revisions, average union time was 5.2 months. For revisions, union occurred at an average of 10.2 months after intervention. No association was identified between discontinuation of bisphosphonates and union time (P =0.5) or need for revision (P =0.7). Twenty-one percent sustained contralateral femur fractures; 32% of these had pain and 59% had stress reaction prior to contralateral fracture. CONCLUSIONS:: In this series, surgery had a 12% failure rate and delayed average time to union. Twenty-one percent developed contralateral femur fractures within 2 years, underscoring the need to evaluate the contralateral extremity. LEVEL OF EVIDENCE:: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

AB - OBJECTIVES:: The purpose of this study is to characterize demographics, healing time and complications of a large series of operatively treated atypical femur fractures. DESIGN:: Retrospective multicenter review. SETTING:: 17 academic medical centers. PATIENTS:: Bisphosphonate related fractures as defined by ASBMR. Fractures had to be followed for at least 6 months or to union or revision. INTERVENTION:: Operative treatment of bisphosphonate related fracture. MAIN OUTCOME MEASUREMENTS:: Union time and complications of treatment, as well as information about the contralateral limb. RESULTS:: There were 179 patients, average age 72, average BMI 27.2. Average followup was 17 months. Twenty-one percent had a prior history of fragility fracture; 34% had prodromal pain. Most (88%) lived independently before injury. Thirty-one percent had radiographic changes suggesting stress reaction. Surgical fixation was with cephalomedullary nail (51%), IM nail (48%) or plate (1%). Complications included death (4), PE (3), and wound infection (6). Twenty (12%) patients underwent revision at an average of 11 months. Excluding revisions, average union time was 5.2 months. For revisions, union occurred at an average of 10.2 months after intervention. No association was identified between discontinuation of bisphosphonates and union time (P =0.5) or need for revision (P =0.7). Twenty-one percent sustained contralateral femur fractures; 32% of these had pain and 59% had stress reaction prior to contralateral fracture. CONCLUSIONS:: In this series, surgery had a 12% failure rate and delayed average time to union. Twenty-one percent developed contralateral femur fractures within 2 years, underscoring the need to evaluate the contralateral extremity. LEVEL OF EVIDENCE:: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

UR - http://www.scopus.com/inward/record.url?scp=84952033855&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84952033855&partnerID=8YFLogxK

U2 - 10.1097/BOT.0000000000000516

DO - 10.1097/BOT.0000000000000516

M3 - Article

C2 - 26709814

AN - SCOPUS:84952033855

JO - Journal of Orthopaedic Trauma

JF - Journal of Orthopaedic Trauma

SN - 0890-5339

ER -