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Bilateral atypical femoral fractures: how much symmetry is there on imaging?

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Abstract

Objective

To evaluate bilateral atypical femoral fractures (AFFs) and to compare imaging features of paired fractures.

Materials and methods

Bilateral femoral imaging studies of 124 patients on bisphosphonate therapy with at least one AFF were retrospectively reviewed. Time between AFF diagnoses was determined. The following imaging features were evaluated for each AFF: fracture location, femoral angle, length of cortical thickening, medial spike location, fracture orientation, and comminution. Associations between imaging findings on pairs of bilateral AFFs were assessed with Spearman’s correlation (rs) and the Kappa statistic (κ).

Results

Bilateral AFFs were present in 78/124 (62.9 %) cases (3 men, 75 women; mean age 67.3 years). Average time between contralateral AFF diagnoses was 10.3 months. Contralateral AFFs were diagnosed within 12 months of the index fracture in 60/78 (76.9 %) cases and within 3 years in 69/78 (88.5 %) cases. There was a strong correlation between bilateral AFF locations (rs = 0.65), with 58/76 (76.3 %) occurring within a distance of <5 cm and 41/76 (53.9 %) within a distance of ≤2.5 cm. Bilateral AFF pairs had moderately correlated femoral angles (rs = 0.42), and weakly correlated lengths of cortical thickening (rs = 0.28). There was substantial agreement for medial spike location (κ = 0.68) and fracture orientation (κ = 0.64), and moderate agreement for lack of comminution (κ = 0.42). All findings were independent of time between AFF diagnoses.

Conclusions

Patients with unilateral atypical femoral fractures are likely to be diagnosed with a contralateral AFF within the first year of presentation. Bilateral AFFs commonly have similar imaging features, including location along the femur.

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Acknowledgments

This study was not financially sponsored by any organization.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medical Imaging, University of Toronto, 263 McCaul Street, 4th Floor, Toronto, ON, M5T 1W7, Canada

    Linda Probyn, Catherine Lang & Robert Bleakney

  2. Toronto General Research Institute, Toronto General Hospital, University Health Network, Toronto, ON, Canada

    Angela M. Cheung & George Tomlinson

  3. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Angela M. Cheung & Robert G. Josse

  4. Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Leon Lenchik

  5. Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

    Jonathan D. Adachi & Aliya Khan

  6. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    George Tomlinson

  7. Joint Department of Medical Imaging, Toronto, ON, Canada

    Robert Bleakney

  8. Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Linda Probyn

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  1. Linda Probyn
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  2. Angela M. Cheung
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  3. Catherine Lang
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Correspondence to Linda Probyn.

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Probyn, L., Cheung, A.M., Lang, C. et al. Bilateral atypical femoral fractures: how much symmetry is there on imaging?. Skeletal Radiol 44, 1579–1584 (2015). https://doi.org/10.1007/s00256-015-2212-7

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  • DOI: https://doi.org/10.1007/s00256-015-2212-7

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