P845 ATYPICAL FEMORAL FRACTURES: CASE SERIES AND PROPOSAL OF AN ALGORITHM FOR MANAGEMENT

Objective: To purpose a practical tool for approaching atypical femoral fractures (AFF) considering the current evidences and experience of a multidisciplinary study group. Material and Methods: We examined a series of clinical cases with a diagnosis of AFF according with 2013 ASBMR criteria. After a consensus of our study group, we purposed an algorithm in order to improve the knowledge in terms of early diagnosis and conservative and surgical treatment. Results: From the analysis of 30 clinical cases of AFF (28 female and 2 male, mean aged 76.06 ± 6.56 years) our group debated on 4 main topics regarding the AFF: diagnosis, evaluation of bone turnover, treatment of the fractured femur, and management of the contralateral femur. These clinical issues represented the 4 steps of our proposed algorithm. Figure 1. AFF complicated by an intraoperative fracture and subsequent infection. A) Pre-operative X-ray showing an incomplete AFF in a very bowed femur; B) Reduction and synthesis of the intraoperative fracture using a locking plate; C) External fixation after removal of locking plate because of the development of an infection. Conclusions: A multidisciplinary approach is mandatory in order to face up the AFF. Based on our clinical experience, we proposed a practical guide for diagnosis and management of AFF. However, there is a lack of adequate evidences on treatment of AFF and further studies are needed. Osteoporos Int