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Histology of 8 atypical femoral fractures: remodeling but no healing.
- Source :
-
Acta orthopaedica [Acta Orthop] 2014 Jun; Vol. 85 (3), pp. 280-6. Date of Electronic Publication: 2014 Apr 30. - Publication Year :
- 2014
-
Abstract
- Background and Purpose: The pathophysiology behind bisphosphonate-associated atypical femoral fractures remains unclear. Histological findings at the fracture site itself may provide clues.<br />Patients and Methods: Between 2008 and 2013, we collected bone biopsies including the fracture line from 4 complete and 4 incomplete atypical femoral fractures. 7 female patients reported continuous bisphosphonate use for 10 years on average. 1 patient was a man who was not using bisphosphonates. Dual-energy X-ray absorptiometry of the hip and spine showed no osteoporosis in 6 cases. The bone biopsies were evaluated by micro-computed tomography, infrared spectroscopy, and qualitative histology.<br />Results: Incomplete fractures involved the whole cortical thickness and showed a continuous gap with a mean width of 180 µm. The gap contained amorphous material and was devoid of living cells. In contrast, the adjacent bone contained living cells, including active osteoclasts. The fracture surfaces sometimes consisted of woven bone, which may have formed in localized defects caused by surface fragmentation or resorption.<br />Interpretation: Atypical femoral fractures show signs of attempted healing at the fracture site. The narrow width of the fracture gap and its necrotic contents are compatible with the idea that micromotion prevents healing because it leads to strains within the fracture gap that preclude cell survival.
- Subjects :
- Absorptiometry, Photon
Aged
Aged, 80 and over
Biopsy
Bone Density physiology
Bone Remodeling physiology
Bone Resorption physiopathology
Cell Survival physiology
Female
Femoral Fractures physiopathology
Femur diagnostic imaging
Femur physiopathology
Humans
Male
Middle Aged
Osteoclasts pathology
Osteoclasts physiology
Retrospective Studies
Tomography, X-Ray Computed
Wound Healing physiology
Diphosphonates adverse effects
Diphosphonates therapeutic use
Femoral Fractures chemically induced
Femoral Fractures pathology
Femur pathology
Osteoporosis prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1745-3682
- Volume :
- 85
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Acta orthopaedica
- Publication Type :
- Academic Journal
- Accession number :
- 24786905
- Full Text :
- https://doi.org/10.3109/17453674.2014.916488