IM Nail Fixation of Atypical Femur Fractures with Bone Marrow Aspirate Concentrate Leads to Faster Union: A Case Control Study

High rates of implant failure and nonunion in atypical femur fractures (AFF) have been reported. The aim of this study was to evaluate bone marrow aspirate concentrate (BMAC) use in the treatment of AFF. Retrospective Case Control SETTING:: Level 1 Trauma Center PATIENTS:: Complete AFF, defined according to American Society of Bone and Mineral Research (ASBMR) criteria, from September 2009 to April 2015 with minimum 1 year follow up. Operative treatment with anterograde intramedullary (IM) nails. Beginning June 2014, BMAC from the ipsilateral iliac crest was added to all AFFs. Time to union as determined by a blinded panel of 3 Attending Orthopaedic Surgeons, union rates, complications. 35 patients with 36 AFFs were reviewed, of which 33 AFFs were included and 11 received BMAC. Aledronate was the most commonly prescribed bisphosphonate, with a similar mean duration of use in controls and BMAC cases (5.6 vs 6 years, p=0.79). BMAC use significantly decreased time to union (3.5 vs 6.8 months, p=0.004). Varus malreduction was associated with a significant delay in union (9.7 vs 4.7 months, p=0.04). Overall one year union rate was 86.2%, and nonsignificantly higher in BMAC compared to controls (100.0% vs. 77.3%, p=0.11). Multivariate analysis revealed BMAC and varus malreduction as independent predictors of time to union. There were no complications related to BMAC use. Our findings support IM nailing of AFF as an effective treatment option with a low surgical complication rate and highlight the importance of avoiding varus malreduction. BMAC use significantly reduced time to fracture union without an increase in surgical complication rates. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.