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

Katrina Harborne, Jonathan Hazlehurst

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)



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.

Advances in knowledge:

We have raised awareness of the importance of recognizing AFFs to guide management.
Original languageEnglish
Article number20150443
JournalBritish Journal of Radiology
Issue number1057
Early online date12 Nov 2015
Publication statusPublished - 2016


Dive into the research topics of 'Compliance with established guidelines for the radiological reporting of atypical femoral fractures'. Together they form a unique fingerprint.

Cite this