Predicting Need for Fixation of Atypical Femoral Fracture

Context: Predictors of the requirement for fixation have not been reported in incomplete atypical femoral fractures. The clinical features of incomplete atypical femoral fractures should be reviewed to predict the requirement for surgical intervention in this condition. Objective: Our purposes were (1) to evaluate the clinical results of incomplete atypical femoral fracture and (2) to determine the factors associated with the requirement for fixation in incomplete atypical femoral fractures. Design, Setting, and Patients: We retrospectively reviewed the medical records of 51 patients with a total of 65 incomplete atypical femoral fractures from 3 tertiary referral centers. Minimum follow-up was 12 months (mean, 19.8 months; range, 12–82 months). Intervention: The study consisted of fixation-requiring and non–fixation-requiring groups. Main Outcome Measure: The main outcome measure was the requirement for fixation. Results: Thirty-one (47.7 %) hips required internal fixation. Cox regression analysis showed that the subtrochanteric location was significantly associated with the requirement for fixation (hazard ratio, 2.713; 95% confidence interval, 1.189–6.189) Conclusions: About one-half of incomplete atypical femur fractures required surgical intervention, and subtrochanteric involvement could be used as a predictor of the requirement for fixation in these conditions.