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Updated: Mar 28, 2026
Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Healing Time and Complications in Operatively Treated Atypical Femur Fractures Associated With Bisphosphonate Use: A
Yelena Bogdan1, Paul Tornetta, Thomas A Einhorn
1*Boston University Medical Center, Boston MA; †University of British Columbia, Vancouver, BC, Canada; ‡Dalhousie University, Halifax, Canada; §Carolinas Medical Center, Charlotte, NC; ‖Geisinger, Danville, PA; ¶Orthopaedic Associates of Michigan, Grand Rapids, MI; **St. Michael's Hospital, Toronto, Canada; ††Tampa General Hospital, Tampa, FL; ‡‡Scott & White Hospital, Temple, TX; §§Washington University-St Louis, St Louis, MO; ‖‖MetroHealth Medical Center, Cleveland, OH; ¶¶London Health Science Center, London, Ontario, Canada; ***Lahey Clinic, Burlington, MA; †††University of Utah, Salt Lake City, UT; ‡‡‡Fort Worth, TX; §§§Stony Brook University, Stony Brook, NY; and ‖‖‖Oregon Health and Sciences University, Portland, OR.
Objectives:
The purpose of this study was to characterize demographics, healing time, and complications of a large series of operatively treated atypical femur fractures.
Design:
Retrospective multicenter review.
Setting:
Seventeen academic medical centers.
Patients:
Bisphosphonate-related fractures as defined by American Society of Bone and Mineral Research. 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 body mass index 27.2. Average follow-up was 17 months. Twenty-one percent had a previous 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 before 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.
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