• Yelena Bogdan, Paul Tornetta, Thomas A Einhorn, Pierre Guy, Lise Leveille, Juan Robinson, Michael J Bosse, Nikkole Haines, Daniel Horwitz, Clifford Jones, Emil Schemitsch, Claude Sagi, Bryan Thomas, Daniel Stahl, William Ricci, Megan Brady, David Sanders, Michael Kain, Thomas F Higgins, Cory Collinge, Stephen Kottmeier, and Darin Friess.
• *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.
• J Orthop Trauma. 2016 Apr 1; 30 (4): 177-81.

ObjectivesThe purpose of this study was to characterize demographics, healing time, and complications of a large series of operatively treated atypical femur fractures.DesignRetrospective multicenter review.SettingSeventeen academic medical centers.PatientsBisphosphonate-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.InterventionOperative treatment of bisphosphonate-related fracture.Main Outcome MeasurementsUnion time and complications of treatment, as well as information about the contralateral limb.ResultsThere 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.ConclusionsIn 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 EvidenceTherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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