Harborne Katrina, Hazlehurst Jonathan M, Shanmugaratnam Hari, Pearson Samuel, Doyle Alison, Gittoes Neil J, Choudhary Surabhi, Crowley Rachel K
1 Department of Radiology, University Hospitals Birmingham, Birmingham, UK.
2 Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
Br J Radiol. 2016;89(1057):20150443. doi: 10.1259/bjr.20150443. Epub 2015 Oct 28.
Atypical femoral fractures (AFFs) are important to diagnose early to avoid progression to complete fracture. We set out to determine the reporting accuracy of AFFs.
We conducted a retrospective analysis of imaging performed between November 2010 and June 2013 to analyse the X-ray reporting of AFFs and to describe the key clinical considerations. Radiological reports were reviewed from the 3805 separate femoral images for search terms thought likely to identify AFFs. This identified 1558 patients. The identified radiographs were reviewed by radiologists with reference to the 2010 American Society of Bone and Mineral Research (ASBMR) criteria.
Within these 1558 patients, 16 patients met the radiological criteria for AFF according to the 2010 ASBMR task force statement of which, although all were identified as fractures, 15 were not reported as "atypical" by the original reporting author and none was formally classified as AFF by the original reporting author. Within the 1558 patients, there were an additional 17 patients labelled as having "atypical" fracture features originally, although only 1 patient met the 2010 ASBMR task force criteria for AFF. Only 13 of 16 patients had imaging of the contralateral femur, and there was a significant delay for those who were imaged (111 ± 44 days). Furthermore, two of the patients with an AFF had previous radiographs demonstrating cortical changes indicative of AFFs prior to formal diagnosis.
Whilst AFFs are rare diagnoses, the compliance with published guidelines for their radiological classification is low.
We have raised awareness of the importance of recognizing AFFs to guide management.
非典型股骨骨折（AFFs）早期诊断很重要，可避免发展为完全骨折。我们旨在确定AFFs的报告准确性。
我们对2010年11月至2013年6月期间进行的影像学检查进行回顾性分析，以分析AFFs的X线报告并描述关键的临床注意事项。从3805张不同的股骨影像的放射学报告中查找可能识别AFFs的检索词。这确定了1558名患者。由放射科医生参照2010年美国骨与矿物质研究学会（ASBMR）标准对识别出的X线片进行复查。
在这1558名患者中，根据2010年ASBMR工作组声明，有16名患者符合AFF的放射学标准，其中尽管所有患者均被识别为骨折，但15名患者未被原始报告作者报告为“非典型”骨折，且没有一名患者被原始报告作者正式分类为AFF。在这1558名患者中，另外有17名患者最初被标记为具有“非典型”骨折特征，尽管只有1名患者符合2010年ASBMR工作组的AFF标准。16名患者中只有13名对侧股骨进行了成像，且成像患者有明显延迟（111±44天）。此外，两名AFF患者在正式诊断之前的既往X线片显示有提示AFFs的皮质改变。
虽然AFFs是罕见诊断，但对其放射学分类的已发表指南的依从性较低。
我们提高了对识别AFFs以指导治疗的重要性的认识。
