Unitized Nail–Plate Construct for Atypical Femur Fracture Fixation tied to superior outcomes: study

Written by Dr Supreeth D R Published On 2025-09-19T21:15:46+05:30 | Updated On 19 Sept 2025 9:16 PM IST

Unitized Nail–Plate Construct for Atypical Femur Fracture Fixation tied to superior outcomes: study

Atypical femoral fractures (AFFs) are an uncommon yet serious complication associated with long-term bisphosphonate use for osteoporosis treatment. Despite their rising incidence, the optimal management strategy for AFFs is still a work in progress.

Intramedullary nailing has traditionally been the preferred treatment; however, literature reports surprisingly high complication rates. The study by Vivek Shetty et al evaluated the clinical outcomes of unitized nail–plate construct (NPC)— “Linking the nail with the plate with locking bolts through the plate and nail, proximal and distal to the fracture site”—as a primary fixation method for AFFs. It has been published in ‘Indian Journal of Orthopaedics.’

A retrospective review of 17 AFF cases was conducted. After applying inclusion criteria defined by the 2013 American Society of Bone and Mineral Research (ASBMR) task force document, 14 AFFs (13 patients: 12 unilateral AFFs and 1 bilateral AFF) treated with unitized NPC were included in the study. Outcomes were assessed based on time to fracture union, independent mobilization, and return to activities of daily living (ADL).

The key findings of the study were:

• The cohort consisted entirely of female patients with a mean age of 70.1 years (range: 56–84) and an average bisphosphonate therapy duration of 5.1 years (range: 1.5–11.5) prior to fracture.

• The group included 3 subtrochanteric and 11 diaphyseal fractures.

• The mean follow-up duration was 22 months (range: 14–58 months), with an average hospital stay of 7.2 days (range: 4–13 days) and a mean surgical time of 72 min (range 58–96 min).

• All 14 fractures healed without complications, with a mean time to union of 17.5 weeks (range: 12–23 weeks).

• There were no cases of non-union, implant failure, delayed union, or need for secondary procedures.

• The mean time to independent mobilization was 14 weeks (range:9–23 weeks), and 12 patients were able to resume ADL independently by the 1-year follow-up.

The authors concluded - “While unitized NPC requires additional surgical time and expertise, its superior outcomes in AFFs suggest it may be a viable primary fixation strategy, especially in these notorious fractures where failure rates have been historically high.”

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.