ABSTRACT
Bisphosphonate treatment of osteoporosis is now well established, with proven benefit for patients. Prolonged treatment has however presented orthopaedic surgeons with the challenging problem of bisphosphonate-related atypical femoral fractures (AFFs). These AFFs occur due to the bisphosphonate interference with bone homeostasis and are recognizable due to well-defined radiological features. When they occur, AFFs are difficult to treat due to slow healing time and intolerance to any malreduction, which leads to nonunion and often fixation failure. This chapter outlines our experience and outcomes when managing these cases both primarily and when dealing with the all too frequently required salvage procedure needed if initial treatment with an intramedullary nail device has failed.
