Compliance with established guidelines for the radiological reporting of atypical femoral fractures.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
Whilst AFFs are rare diagnoses, the compliance with published guidelines for their radiological classification is low.


CONCLUSIONS
We have raised awareness of the importance of recognizing AFFs to guide management.
1 Department of Radiology, University Hospitals Birmingham, Birmingham, UK.
Katrina
K
Harborne
2 Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
Jonathan M
JM
Hazlehurst
3 Department of Endocrinology, University Hospitals Birmingham, Birmingham, UK.
Hari
H
Shanmugaratnam
3 Department of Endocrinology, University Hospitals Birmingham, Birmingham, UK.
Samuel
S
Pearson
4 Falls and Fracture Prevention Service, University Hospitals Birmingham, Birmingham, UK.
Alison
A
Doyle
3 Department of Endocrinology, University Hospitals Birmingham, Birmingham, UK.
Neil J
NJ
Gittoes
1 Department of Radiology, University Hospitals Birmingham, Birmingham, UK.
Surabhi
S
Choudhary
5 Department of Endocrinology, St Vincent's Hospital, Elm Park, Dublin & University College, Dublin, Ireland.
Rachel K
RK
Crowley
D000368:Aged; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging*; D005269:Femur / Q000000981:diagnostic imaging* / Q000293:injuries*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies