Surgical treatment of patients with atypical femoral fractures of various origins: clinical cases

BACKGROUND: Atypical femur fractures (AFF) are rare stress or fatigue fractures that occur between the subtrochanteric and supracondylar zones and initially affect the lateral wall of the femur, develop over time, most often after long-term suppression of bone remodeling with drugs for the treatment of osteoporosis. To date, a connection has been established between the development of AFFs and the use of bisphosphonates, corticosteroids, Denosumab and Romosozumab, ion pump inhibitors, belonging to the Asian race and varus deformity of the femur. In the modern literature, the issues of conservative treatment and preventive osteosynthesis of incomplete AFFs are discussed. And the methods of osteosynthesis for completed fractures. Most authors are inclined to the need for preventive osteosynthesis for incomplete fractures and intramedullary locking osteosynthesis for completed atypical femur fractures.

CLINICAL CASES DESCRIPTION: The article presents three clinical cases. The first one demonstrates approaches to treating an elderly patient with AFFs on long-term bisphosphonate therapy. One femur with a completed fracture is consolidated after revision surgery, the contralateral femur requires revision surgery after intramedullary locking osteosynthesis. The second case demonstrates the results of surgical treatment of the young patient with completed and incomplete fractures on the background of varus deformity of the femurs. On the one hand, the femur with a completed fracture is consolidated after repeated revision surgeries to eliminate the deformity, the second femur with an incomplete fracture is consolidated on the background of conservative treatment. And the third clinical case demonstrates the results of treating a middle-aged patient with bilateral AFFs of unknown genesis. A completed femur fracture was consolidated after osteosynthesis with two plates, the contralateral femur with an incomplete fracture united after lateral compression plating.

CONCLUSION: The approaches and treatment results for patients demonstrated in the article partially coincide with literature data and allow formulating approaches to the treatment of AFFs. Incomplete fractures can be successfully treated with osteosynthesis with one lateral plating in a compression mode or with intramedullary locking osteosynthesis. Completed and non-unified AFFs should be rigidly fixed, for example, with two plates. Bone grafting can increase the likelihood of union in completed fractures and non-unions after them.