Investigation of nonunion problems in femoral diaphyseal fractures caused by long-term antiresorptive drug use

Investigation of Nonunion Problems in Femoral Diaphyseal Fractures Caused by Long-Term Antiresorptive Drug Use Purpose: Our aim is to investigate the reasons that may affect union in patients with atypical diaphyseal fractures of the femur due to long-term antiresorptive drug use and who are undergoing surgery. Method: In our study, patients who underwent surgery with intramedullary nailing due to atypical femoral diaphyseal fractures between January 2017 and August 2023 were retrospectively examined. 20 patients who had used antiresoptive drugs for more than one year, were over 60 years of age, and met the atypical femur diagnosis criteria by ASBMR (American Society for the Study of Bone and Mineralization) were included in the study. In our study, patients with atypical femur fractures and fractures in the femoral diaphysis anatomically were included, and fractures that did not fit into this region were excluded from the study. All patients included in the study were female. Union was observed in 11 of the 20 patients included in the study, and a delay in union was observed in 9 patients. Two groups were created, those with and without union, and serum Ca, Lumbar T score, age, duration of antiresorptive drug use and post-surgical reduction were compared between the two groups in terms of their predictive effects on union in atypical femur fractures. Results: When the 20 patients included in the study were evaluated in terms of age, duration of drug use, T-score and corrected blood sugar level parameters, the average age was found to be 75.5 years. The average duration of drug use was 68 months, the average T-score was - 3.7, and the average Corrected serum Ca level was 8.6. Union was observed in 6 months after surgery in 11 patients (55%), and no union was observed in 9 patients in the first 6 months (45%). Conclusion: When patients with and without union were evaluated in terms of t score, age, duration of drug use and serum Ca values, these values did not have a predictive effect on union in atypical femur fractures. The quality of reduction after surgery has been found to have a positive effect on union.