Injury. 2025 Nov 20;57(2):112902. doi: 10.1016/j.injury.2025.112902. Online ahead of print.
OBJECTIVES: Atypical femoral fractures are associated with high rates of non-union and reoperation due to their complex pathogenesis. There is no consensus in literature on the optimal treatment strategy of these difficult cases. This study demonstrates a standardized management protocol for atypical femoral fracture non-unions, with surgical mechanical alignment of the non-union, without bone grafting or use of biological adjuncts, and with immediate unrestricted weight bearing post operatively. The study aimed to examine whether comparable union and complications rates can be achieved to those published in literature.
METHODS: A retrospective analysis of a prospectively collected trauma database at a tertiary referral centre for non-union was conducted. Demographic data, serial radiographs, and clinical records were reviewed. The primary outcomes were union rate and time to union.
RESULTS: 13 consecutively treated patients with atypical femoral fracture non-union were included with a union rate 92 % (12 out of 13). The single ongoing non-union was in a patient who died shortly post-operatively and once excluded, the union rate was 100 %. 1 of the 12 patients who achieved union required two procedures. The average time to union of the 11 patients who underwent a single procedure for non-union was 8.3 months. The revision fixation methods were reconstruction intramedullary nail (n = 4), a reconstruction type nail with adjuvant plate (n = 5), or a 95-degree blade plate (n = 4). No bone graft or any other biological adjuncts were used in any cases.
CONCLUSIONS: This study demonstrated a comparable union rate for atypical femoral fracture non-unions to studies previously reported and achieved this without any form of bone grafting and no complications from immediate weight bearing. To our knowledge, this is the only case series where no bone grafting was used in the management of AFFNU.
PubMed:41319409 | DOI:10.1016/j.injury.2025.112902