Comparison of Atypical and Osteoporotic Femoral ShaftFractures in the Elderly: A Multicenter Study

In atypical femoral fractures, owing to the high rates of complications and delayed healing that accompany the platefixation, the most favorable treatment is intramedullary nailing. Although there is insufficient evidence, plate fixation is chosen dueto anterolateral bowing of the femur. This study compared the bone healing time and rates of complications in atypical femoral shaftfractures and osteoporotic femoral shaft fractures.Methods. We searched the medical records of 3 institutions in Japan for patientswith femoral shaft fractures who visited between 1 January 2010 and 31 December 2015. We identified 65 patients and excluded 37among these due to high-energy injuries or being younger than 65 years. Among the remaining patients, we identified 17 and 11women with atypical (AFF group) and osteoporotic femoral shaft fractures (OP group), respectively.Results.Insurgicalmethod,there were differences in intramedullary nailing (94.1% versus 27.2%) (𝑝<0.01). The mean bone healing time was 11.1 monthsversus 6.7 months in 2 groups(𝑝<0.01). Iatrogenic femoral fractures during intramedullary nail insertion were observed in bothgroups, and reoperation was only seen in atypical femoral fractures treated with a plate fixation, but there was no difference in therate of complications (23.5% versus 9.1%).Conclusions. In the atypical femoral fracture group, intramedullary nailing was morechosen, but the bone healing time was delayed and plate fixation cases needed reoperation. There was no significant difference inthe rate of complications between the 2 groups.