Plate Fixation for Atypical Fractures of the Femoral Diaphysis

Abstract

Background: Plate fixation for atypical femoral fractures has shown high failure rates compared to intramedullary nail fixation. The aim of this study was to evaluate the radiological results of patients treated with a plate and screws for atypical fractures of the femoral diaphysis.

Methods: This study was conducted retrospectively on 16 patients who had undergone internal fixation using plates for treatment of atypical femoral complete fractures from 2007 to 2015. Nine patients were treated with lag screws and short plates while 7 patients were treated with position screws and long plates, which covered the whole femur. Radiologic evaluation was performed on all patients. Complications were also evaluated.

Results: Bone union was achieved in all patients and the average bone union time was 17.7 weeks (range, 14-28 weeks). There was no correlation between the preoperative use of a bisphosphonate, plate length, postoperative teriparatide use, and the time to bone union. Regarding complications, 2 cases of complete fractures and 1 impending fracture occurred at the end of short plates.

Conclusions: Satisfactory results were obtained with use of plates for patients with atypical femoral complete diaphyseal fractures, in whom intramedullary nails could not be applied due to severe bowing. In particular, it seemed advantageous compared with intramedullary nail fixation in that it could maintain the leg length through anatomical reduction and prevent iatrogenic fracture.

Keywords: Atypical femoral fracture; Diaphysis; Plate fixation.

Fig. 1. Preoperative (A), immediate postoperative (B), and 4-month follow-up (C) anteroposterior radiographs of an 89-year-old female patient showing an atypical femoral fracture fixed with interfragmentary screws and a short protection plate.

Fig. 2. Preoperative (A), immediate postoperative (B), and 6-month follow-up (C) anteroposterior radiographs of a 75-year-old female patient showing an atypical femoral fracture fixed with a position screw and a long plate, which covered the entire femur.

Fig. 3. Preoperative (A) and 27-month postoperative (B) anteroposterior radiographs of a 71-year-old female patient. (C) Hot uptake around the proximal end of the plate on the bone scan (black arrow). (D) Anteroposterior radiograph after revision surgery with long plate fixation.