AIMS: Treatment guidelines for @entity3330 associated with @entity171 have not been established. We conducted a systematic review of the treatment of @entity3330 first, to evaluate the outcomes of surgical fixation of complete atypical @entity174 and secondly, to assess whether prophylactic surgery is necessary for incomplete atypical @entity174 . MATERIALS AND METHODS: Case reports and series were identified from the PubMed database and were included if they described the treatment of @entity3330 . In total, 77 publications met our inclusion criteria and 733 @entity1 with 834 atypical @entity3330 were identified. RESULTS: For complete @entity174 , internal fixation was predominantly achieved by intramedullary nailing. The mean time to healing post-operatively was 7.3 months (2 to 31). Revision surgery for nonunion or implant failure was needed in 77 @entity174 (12.6%). A greater percentage of @entity174 treated with plate fixation (31.3%) required revision surgery than those treated with intramedullary nailing (12.9%) (p < 0.01). Non-operative treatment of incomplete @entity174 failed and surgery was eventually needed in nearly half of the @entity1 (47%), whereas prophylactic surgery was successful and achieved a 97% rate of healing. CONCLUSION: Intramedullary nailing is the first-line treatment for a complete @entity174 , although the risk of @entity245 and revision surgery seems to be higher than with a typical @entity3330 . Non-operative treatment does not appear to be a reliable way of treating an incomplete @entity174 : prophylactic intramedullary nailing should be considered if the @entity1 is in intractable @entity158 . Radiographs of the opposite side should be obtained routinely looking for an asymptomatic @entity174 . Bisphosphonates must be discontinued but ongoing metabolic management in the form of @entity460 and/or @entity560 supplements is advisable. Teriparatide therapy can be considered as an alternative treatment. Cite this article: Bone Joint J 2017;99-B:295-302.

XXXX related to bisphosphonate treatment: issues and controversies related to their surgical management.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity171 :: ('MESH:D004164', 'Chemical') :: ['bisphosphonates'] @entity174 :: ('MESH:D050723', 'Disease') :: ['fractures', 'fracture'] @entity245 :: ('MESH:D002658', 'Disease') :: ['delayed healing'] @entity158 :: ('MESH:D010146', 'Disease') :: ['pain'] @entity460 :: ('MESH:D002118', 'Chemical') :: ['calcium'] @entity3330 :: ('MESH:D005264', 'Disease') :: ['femoral fracture', 'atypical femoral fractures', 'complete or incomplete femoral fractures'] @entity560 :: ('MESH:D014807', 'Chemical') :: ['vitamin D']
@entity3330 :: (MESH:D005264,Disease) :: ['Atypical femoral fractures']
