Kaiser Permanente Center for Health Research NW, 3800 N. Interstate Ave, Portland, OR, 97227, USA.
University of California, San Francisco (UCSF), San Francisco, CA, USA.
Osteoporos Int. 2019 Jun;30(6):1287-1295. doi: 10.1007/s00198-019-04869-z. Epub 2019 Feb 26.
The paper focuses on the identification of atypical fractures (AFFs). This paper examines the concordance between objective classification and expert subjective review. We believe the paper adds critical information about how to apply the American Society of Bone and Mineral Research (ASBMR) criteria to diagnose AFFs and is of high interest to the field.
Assess American Society of Bone and Mineral Research (ASBMR) criteria for identifying atypical femoral fractures (AFFs).
Two orthopedic surgeons independently evaluated radiographs of 372 fractures, applying ASBMR criteria. We assessed ease of applying ASBMR criteria and whether criteria-based assessment matched qualitative expert assessment.
There was up to 27% uncertainty about how to classify specific features. 84% of films were classified similarly for the presence of AFF according to ASBMR criteria; agreement increased to 94% after consensus meeting. Of 37 fractures categorized as AFFs based on ASBMR criteria, 23 (62.2%) were considered AFFs according to expert assessment (not relying on criteria). Only one (0.5%) femoral shaft fracture that did not meet ASBMR criteria was considered an AFF per expert assessment. The number of major ASBMR features present (four vs five) and whether there was periosteal or endosteal thickening ("beaking" or "flaring") played major roles in the discrepancies between ASBMR criteria-based and expert-based determinations.
ASBMR AFF criteria were useful for reviewers but several features were difficult to interpret. Expert assessments did not agree with the ASBMR classification in almost one-third of cases, but rarely identified an AFF when a femoral shaft fracture did not meet ASBMR AFF criteria. Experts identified lateral cortical transverse fracture line and associated new-bone formation along with no or minimal comminution as crucial features necessary for the definition of atypical femoral fractures.
本文专注于非典型性骨折（AFF）的识别。本文探讨了客观分类与专家主观评估之间的一致性。我们认为，本文提供了有关如何应用美国骨骼与矿物质研究学会（ASBMR）标准来诊断 AFF 的重要信息，并且对该领域具有高度的兴趣。
评估美国骨骼与矿物质研究学会（ASBMR）标准，以识别非典型性股骨骨折（AFF）。
两位矫形外科医生独立评估了 372 例骨折的 X 光片，应用 ASBMR 标准。我们评估了应用 ASBMR 标准的难易程度，以及基于标准的评估是否与定性专家评估相匹配。
在如何对特定特征进行分类方面存在高达 27%的不确定性。根据 ASBMR 标准，84%的 X 光片在 AFF 存在方面的分类相似；在共识会议后，一致性增加到 94%。根据 ASBMR 标准，37 例骨折被归类为 AFF ；根据专家评估（不依赖标准），其中 23 例（62.2%）被认为是 AFF。根据专家评估，仅有一种（0.5%）未满足 ASBMR 标准的股骨干骨折被认为是 AFF。存在的主要 ASBMR 特征数量（4 个与 5 个）以及是否存在骨膜或骨内膜增厚（“喙状”或“喇叭状”）在 ASBMR 标准与专家评估之间的差异中起主要作用。
ASBMR AFF 标准对审查员有用，但有几个特征难以解释。在近三分之一的情况下，专家评估与 ASBMR 分类不一致，但很少在股骨干骨折不符合 ASBMR AFF 标准的情况下确定 AFF。专家确定了横向皮质横断骨折线和新骨形成以及无或最小的粉碎，这是定义非典型性股骨骨折所必需的关键特征。
