Surgical Difficulties and Complications in the Treatment of Bisphosphonate-related Proximal Femur Fractures

Background: Atypical proximal femoral fractures are becoming more common. They are difficult to treat because of the poor union rate and potential surgical difficulties due to hard bone and complete obliteration of the medullary canal. Methods: This is a case series of five patients with bisphosphonate-related atypical proximal femur fractures. The study period was between June 2012 and October 2013. The patients were treated using cephalomedullary devices. The intraoperative difficulties and postoperative complications were recorded. Results: We noticed complete femoral canal obliteration in two cases that required a set of addition reamers to reach the medullary canal. Moreover, the nonunion was 100% in the patient treated with standard nail and 25% in patients treated with long nail, and these nonunion rates were much higher than ordinary fractures. Conclusion: Treatment of atypical femoral fractures can be difficult. Thus, proper preparations and expertise are required. Additional medical therapies may also be beneficial