Vigorous Endosteal Reaming across Fracture Site to Aid Union in Atypical Femur Fractures

Background: Bisphosphonate abuse is associated with atypical femur fractures, which despite different fixation methods have increased non-union, delayed union, and re-operation rates. Therefore, there is a need for a surgical technique that may enhance union in such cases. Herein we are introducing a novel technique of sequential multiple vigorous reaming across the fracture site to introduce reaming debris/endosteal bone graft around the fracture site. Materials and Methods: We present a retrospective analysis of five prospectively treated patients with atypical diaphyseal femur fracture who presented to us from January 2015 to August 2019. All the patients were followed up at regular intervals and assessed both clinically and radiologically. Results: All 5 cases operated with our technique showed union at a mean follow-up of 16 weeks (12 - 20 weeks). There were no complications reported in our study at the last mean follow-up of 25 months (12 - 51 months). Conclusion: This technique of multiple vigorous reaming at and around the fracture site provides a new paradigm in the management of AFF. The autograft around the outer cortex promotes the formation of bridging callus and results in the early union.