Table 2.

The American Society for Bone and Mineral Research Task Force 2013 Revised Case Definition of Atypical Femoral Fractures.

ASBMR: Definition of AFF
To satisfy the case definition of AFF, the fracture must be located along the femoral diaphysis from just distal to the lesser trochanter to just proximal to the supracondylar flare
In addition, at least four of five major features must be present; none of the minor features is required, but they have sometimes been associated with these fractures
Major Features
  • Minimal trauma
  • Fracture originates laterally and is transverse
  • Complete fractures may have medial spike; incomplete only involve lateral cortex
  • Non-comminuted or minimally comminuted
  • Localized periosteal or endosteal thickening of the lateral cortex (“beaking” or “flaring”)
Minor Features
  • Generalized increase in cortical thickness of femoral diaphyses
  • Unilateral or bilateral prodromal symptoms—dull ache in groin or thigh
  • Bilateral incomplete or complete femoral diaphysis fractures
  • Delayed fracture healing
  • Fractures of the femoral neck
  • Intertrochanteric fractures with spiral subtrochanteric extension
  • Periprosthetic fractures
  • Pathological fractures associated with primary or metastatic bone tumors and miscellaneous bone diseases (e.g. Paget’s disease, fibrous dysplasia)

Taken from: Shane E, Burr D, Abrahamsen B, et al.11 Reproduced with permission of John Wiley & Sons, © 2014 American Society for Bone and Mineral Research.

RMMJ Rambam Maimonides Medical Journal Rambam Health Care Campus 2016 October; 7(4): e0032.
Special Issue on Rheumatology Guest Editor: Alexandra Balbir-Gurman, M.D.
ISSN: 2076-9172
Published online 2016 October 31. doi: 10.5041/RMMJ.10259