Ji Hae Park BS, Presenter: Nothing to Disclose

Zehava Sadka Rosenberg MD, Abstract Co-Author: Nothing to Disclose

Jenny T. Bencardino MD, Abstract Co-Author: Nothing to Disclose

Valerie Peck MD, Abstract Co-Author: Nothing to Disclose

Nirmal C. Tejwani MD, Abstract Co-Author: Royalties, Biomet, Inc Consultant, Stryker Corporation Speaker, Stryker Corporation Consultant, Zimmer Holdings, Inc Speakers bureau, Zimmer Holdings, Inc

Kenneth A. Egol MD, Abstract Co-Author: Nothing to Disclose

Correlate baseline imaging score, utilizing radiographs and MRIs, of incomplete atypical femoral fractures, in patients on long term bisphosphonate therapy (PB), with radiographic and clinical outcome (based on Short Musculoskeletal Functional Assessment).

Review of 101 atypical femoral fractures in 68 patients on long term bisphosphonate (BP) revealed 41 patients (all women) with incomplete atypical femoral fractures (IAFF). IAFF was defined as lateral focal cortical thickening (LFCT) with/without fracture line. Eleven patients and 16 IAFF were excluded due to insufficient radiographs, absence of long-term follow up or progression to complete fractures. The final cohort was 30 patients with 38 incomplete fractures (average age, 72 years, range, 48-92 years). The following data was recorded: 1. Radiographic and MRI evidence of lateral focal cortical thickening, fracture line, endosteal thickening, and marrow edema, 2. Non-operative vs. operative treatment, and 3. Healing on follow-up radiographs. All patients underwent a Short Musculoskeletal Functional Assessment (SMFA) at mean 21.3 months (range, 6-65 months) post presentation. Data was analyzed by Student’s T-test and Fisher’s exact test.

 There was no statistical correlation between baseline imaging score and final radiographic outcome. In the non-operatively treated cohort (14 patients, 16 fractures), baseline x-ray score and baseline combined x-ray and MRI score showed statistically significant correlations with pain after treatment (p=0.023, p=0.021 respectively) and patients’ return to baseline (p=0.012, p=0.003 respectively). Baseline MRI score showed a statistically significant correlation with patients’ return to baseline (p=0.004). In the operatively treated cohort (20 patients, 22 fractures) there were no statistically significant correlation between imaging scores and clinical outcome.  

Baseline x-ray and MRI scores did not predict follow-up radiographic outcome but showed predictive outcomes in non-operatively treated patients with incomplete bisphosphonate associated femoral fractures. 

Radiographs and MRI scoring is useful for predicting clinical outcome in patients on long term BP who are treated conservatively for incomplete, atypical femoral fractures.  

Park, J, Rosenberg, Z, Bencardino, J, Peck, V, Tejwani, N, Egol, K, Can Baseline Radiographic and MRI Scoring Predict Clinical Outcome of Incomplete Atypical Femoral Fracture in Patients on Long Term Bisphosphonate Therapy?.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12033146.html