Surgical management of atypical femur fractures associated with bisphosphonate therapy

Michael Githens, Matthew R. Garner, Reza Firoozabadi

Research output: Contribution to journalReview articlepeer-review

19 Scopus citations


Atypical femur fractures associated with long-term bisphosphonate use can be challenging injuries to manage. Not only do they have a prolonged healing time and increased rate of nonunion as compared to typical femur fractures, intraoperative complications are not infrequent and can be catastrophic. Given the pathologic nature of these fractures, a multidisciplinary approach to the patient’s care is necessary. Treatment begins with medical optimization and careful surgical planning. Radiographic characteristics of the fracture and femoral osteology dictate reduction strategy, adjunctive surgical techniques, and implant choice. Intraoperative complications including malreduction, iatrogenic fracture, and fracture propagation can be avoided with thoughtful planning. The purpose of this article is to discuss the technical aspects of surgical management of atypical femur fractures. We also discuss management of intraoperative complications and treatment failure. Finally, we provide an update on recommendations for postoperative medical treatment and management of the contralateral femur.

Original languageEnglish (US)
Pages (from-to)864-871
Number of pages8
JournalJournal of the American Academy of Orthopaedic Surgeons
Issue number24
StatePublished - Jan 1 2018

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine


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