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The importance of reconstruction nailing for diaphyseal atypical femoral fractures: a comparative study with standard nailing

Authors
Oh, Chang-WugKim, Joon-WooPark, Kyeong-HyeonOh, Jong-KeonYoon, Yong-CheolChung, Seung-Ho
Issue Date
Oct-2022
Publisher
Springer Verlag
Keywords
Diaphyseal atypical femoral fracture; Reconstruction nailing; Standard nailing; Complication
Citation
Archives of Orthopaedic and Trauma Surgery, v.142, no.10, pp 2677 - 2683
Pages
7
Indexed
SCIE
SCOPUS
Journal Title
Archives of Orthopaedic and Trauma Surgery
Volume
142
Number
10
Start Page
2677
End Page
2683
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/55326
DOI
10.1007/s00402-021-04057-x
ISSN
0936-8051
1434-3916
Abstract
Introduction Subtrochanteric atypical femoral fractures (AFFs) usually require long cephalomedullary or reconstruction nailing to achieve satisfactory healing. Recently, this type of nailing has also been recommended to fix diaphyseal AFFs and prevent fragility fractures around the proximal femur, although standard antegrade nailing seems sufficient from a biomechanical perspective. This study aimed to compare treatment outcomes and complications between reconstruction and standard nailing for diaphyseal AFFs. Materials and methods A retrospective comparative study of 48 female patients with diaphyseal AFFs who underwent surgical treatment with either reconstruction or standard nailing was conducted. The reconstruction nailing group comprised 23 patients with a mean age of 74.4 years and included 16 complete and 7 incomplete AFFs. The mean follow-up period was 30 months. The standard nailing group comprised 25 patients with a mean age of 71.1 years and included 16 complete and 9 incomplete AFFs. The mean follow-up period was 57.8 months. The healing rate, time to union, and complications were analyzed and compared between the two groups. Results Bony union was achieved in all 23 cases (100%) of the reconstruction nailing group by a mean of 19.3 weeks postoperative. In the standard nailing group, 23 of 25 cases healed (92%) by a mean of 16 weeks postoperative. The standard nailing group included two delayed fragility fractures of the femoral neck (5 and 10 years after the initial surgery), four cases of newly developed subtrochanteric AFFs at the distal screw of the proximal interlocking screws of the nail (one complete and three incomplete fractures), and two cases of nonunion. Complications only occurred in the standard nailing group (p = 0.01, Fisher’s exact test). Conclusions In diaphyseal AFFs, reconstruction nailing may achieve a satisfactory outcome and can also decrease delayed peri-implant fragility fractures of the hip, newly developed subtrochanteric AFFs, and nonunion.
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Oh, Jong Keon
Guro Hospital (Department of Orthopedic Surgery, Guro Hospital)
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