This study analyzed factors that affect healing time in patients who had operative treatment for complete femoral fractures associated with bisphosphonate use. It found that longer duration of bisphosphonate use (>3 years) was significantly associated with higher rates of problematic healing including delayed union and nonunion. Specifically, supra isthmic fracture location, femoral bowing over 10 degrees, lateral/medial cortex thickness ratio over 1.4, varus reduction, gaps at the fracture site, and cortical breakage were predictive of problematic healing. Reducing gaps at surgery and using intramedullary nails without cortical breakage may help reduce healing time.

1. THE JOURNAL OF BONE AND JOINT SURGERY DEC 2016
PRESENTER : DR. SANDEEP TRIPATHI
MODERATOR : PROF.M.CHANDRASEKARAN

2.  To analyze factors that affect healing time
after operative treatment of complete
femoral fracture associated with
bisphosphonates use
 Study was done in samsung changwon
hospital, south korea from july 2006 to feb
2014

3.  Cohort study
 99 patient (109 fracture)
 Follow up duration 6 to 60 month
 Duration of bisphosphonate use is 7.4 + or -
3.5 years (range 3 to 20 years)
LEVEL OF EVIDENCE: therapeutic level IV

4. RADIOLOGICAL FINDING INCLUDE
 Femoral neck shaft angle
 Coronal and sagittal bowing of the femur
 Thickness of the femoral cortex

5.  Is defined by
 Transverse or short oblique fracture line
 Medial spike
 Focal lateral cortical thickening
 No or minimal comminution

6. BISPHOSPHONATE USED 7.4 +or -3.5 years
(average duration 3 to 20 year)
Long term used defined as more than 3 year
 Alendronate 43 patient
 Risedronate 27
 Ibandronate 11
 Pamidronate 3
 Zoledronate 3

12.  109 fracture- 76 fracture showed union with
in 6 months (successful healing group)
 33 fracture show- delayed union or nonunion
included in problematic healing
27 – delayed union
06- non union

13.  Longer duration (>3 years) of
bisphosphonate use was significantly
associated with a higher rate of problematic
healing
(non union/delayed union)

14. PREDICTIVE TO PROBLEMATIC
HEALING
 Supra isthmic location,
 femoral bowing >10 degree in coronal plane,
 lateral/medial cortex thickness ratio > 1.4
 Varus reduction
 Gap at fracture site anteriorly and lateraly
 Cortical breakage at fracture site

15.  Identified a difference in the duration of
bisphosphonate use between the successful
healing and problematic healing groups
 Long duration use of bisphosphonate
associated with higher rate of problematic
healing
 Reduce the anterior and lateral fracture gap
during surgery will achieving successful
healing

16.  Intrameddullary nail without cortical breakage
around the fracture site and
 decrease the anterior and lateral fracture
gaps as much as possible both
could be helpful in reducing healing time in
complete femoral fracture
Prodromal symptoms are associated with
increase in cortical thickness which increase
the healing time

17.  BIOMED RESEARCH INTERNATIONAL VOLUME
2016 (hindawi)
 Atypical complete femoral fracture associated
with bisphophonate use: (76 patient, 81
fracture)
 Conclusion:
No significant difference

18.  The number of patient was limited
 Risk of observer bias(retrospective)
 Did not evaluate the functional outcome
 Parathyroid hormone not use in this study
 Not investigate calcium and vitamin-D