Atypical femoral fractures are burdened with a high rate of reoperation. In our nationwide analysis, the increased rate of reoperation was related to patient background characteristics, such as age and health status, rather than fracture type. INTRODUCTION Patients with atypical fractures are complex to treat and burdened with a high risk of reoperation. We hypothesized that patients with surgically treated, complete atypical fractures have a higher risk of any reoperation and reoperation related to healing complications than patients with common femoral shaft fractures but that this increase would become insignificant when adjusted for predefined characteristics. METHODS A cohort of 163 patients with atypical fractures and 862 patients with common femoral shaft or subtrochanteric fractures treated from 2008 to 2010 and who had follow-up radiographs and register data available until 31 December 2014 was included. Reoperations were identified by a complementary review of radiographs and register data and were used to calculate risks for any reoperation and reoperations related to healing complications. RESULTS Patients with atypical fractures were more likely to be reoperated for any reason, age-adjusted OR 1.76 (95% CI, 1.08 to 2.86). However, patients with common fractures had a shorter follow-up due to a threefold higher death rate. Accordingly, in a multivariable-adjusted time-to-event model, the increased risk lost statistical significance for any reoperations, cause-specific HR 1.34 (95% CI, 0.85 to 2.13), and for reoperations related to healing complications, HR 1.32 (95% CI, 0.58 to 3.0). Continued use of bisphosphonate in the first year after the fracture did not affect the reoperation rate. CONCLUSIONS Our findings suggest that the increased risk of reoperation after an atypical femur fracture is largely explained by patient characteristics and not fracture type.

中文翻译：

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非典型股骨骨折再手术率增加与患者特征有关，与骨折类型无关。一项全国性队列研究。

非典型股骨骨折的手术率很高。在我们的全国性分析中，再次手术率的提高与患者背景特征（例如年龄和健康状况）有关，而不是与骨折类型有关。引言非典型骨折患者的治疗复杂且重手术风险高。我们假设接受手术治疗的完全性非典型骨折的患者发生再手术和与治愈并发症相关的再手术的风险要比普通股骨干骨折的患者高，但是如果根据预定义的特征进行调整，这种增加将变得微不足道。方法纳入2008年至2010年收治的163例非典型性骨折患者和862例股骨干或股骨转子下骨折的患者，这些患者均接受了X线照片和登记资料，直至2014年12月31日。通过对X线片和记录数据的补充审查来确定再次手术，并用于计算任何再次手术和与治愈并发症相关的再次手术的风险。结果非典型骨折的患者因年龄调整后的手术可能性更高，OR为1.76（95％CI，1.08至2.86）。然而，由于高死亡率三倍，普通骨折患者的随访时间较短。因此，在经过多变量调整的事件发生时间模型中，增加的风险对于任何再次手术均无统计学意义，原因特定的HR为1.34（95％CI，0。85至2.13），以及与治愈并发症相关的再次手术，HR为1.32（95％CI，0.58至3.0）。骨折后第一年继续使用双膦酸盐不影响再次手术率。结论我们的发现表明，非典型股骨骨折后再次手术的风险增加在很大程度上取决于患者的特征而不是骨折类型。