Authors: A L Adams F Xue J Q Chantra R M Dell S M Ott S Silverman J C Giaconi C Critchlow
Publish Date: 2016/10/21
Volume: 28, Issue: 1, Pages: 413-417
Abstract
Using the American Society for Bone and Mineral Research Task Force case definition for atypical femoral fractures sensitivity and specificity of radiographic fracture characteristics were calculated Fracture pattern was the most sensitive and specific characteristic This suggests that some characteristics should be weighted more heavily when identifying these fracturesTo estimate the sensitivity and specificity of each radiographic criterion in the 2013 ASBMR atypical femoral fracture AFF case definition for distinguishing AFF from other subtrochanteric/diaphyseal fractures nonAFF among women enrolled in a large integrated health care organizationRadiographs from 55 physicianconfirmed AFFs and a sample of 39 nonAFFs were reviewed by four independent expert reviewers representing four medical specialties One image per fracture was selected for review Using a standardized data collection tool based on the 2013 AFF case definition reviewers indicated the presence or absence of the following characteristics viewable on radiograph fracture pattern comminution periosteal and/or endosteal thickening and cortical thickening Sensitivity and specificity for each characteristic was calculated for each reviewer and summarized across reviewers with the mean and range Agreement across reviewers was quantified using Fleiss’s kappa FK statisticThe most sensitive factors distinguishing AFF from nonAFF were lateral cortex transverse fracture pattern mean 936 range 855–982 medial cortex transverse or oblique fracture pattern mean 841 range 727–982 and minimal/noncomminution mean 932 range 891–982 Specificity was the greatest for lateral cortex transverse fracture pattern mean 955 range 923–974 Agreement across reviewers was the highest for lateral cortex transverse fracture pattern FK 083 and incomplete fracture through the lateral cortex only FK 080Lateral cortex transverse fracture pattern was the most sensitive and specific characteristic and the most highly agreed upon across reviewers Other characteristics were less readily agreed upon across reviewers Measurement of discrete combinations of individual characteristics may enhance sensitivity and/or specificityAnnette Adams has received research grants or funding from Amgen Inc Merck Inc and Otsuka Pharmaceuticals Fei Xue is an employee of Amgen Inc and holds Amgen stock Cathy Critchlow is an employee of Amgen Inc and holds stock in Amgen Inc Susan Ott gave one lecture and travel and expenses paid by Amgen The following authors declare that they have no conflicst of interest Jean Q Chantra Rick M Dell Stuart Silverman and Joseph GiaconiAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards
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