Abstract

CARABELLI, Guido; BARLA, Jorge  and  SANCINETO, Carlos. Evaluación intraobservador e interobservador en el diagnóstico radiográfico de fracturas asociadas a la ingestión de bifosfonatos. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2015, vol.80, n.4, pp.230-234. ISSN 1852-7434.

Objective: To evaluate the usefulness of X-rays for diagnosing bisphosphonate-related atypical fractures. Methods: Patients with a subtrochanteric and diaphyseal femur fracture admitted from 2006 to 2011 were retrospectively evaluated. Exclusion criteria included neck, intertrochanteric and supracondylar femoral fractures, pathological fractures and pediatric patients. Radiographies were taken in 167 patients with 169 fractures (2 bilateral): 109 diaphyseal and 60 subtrochanteric fractures. Twenty nine were bisphosphonate-related atypical femoral fractures. Seven orthopaedics physicians with different expertise levels reviewed independently the X-rays twice: a) 3 third-year residents; b) 2 with fellowships in knee and shoulder; and c) 2 hip, foot and ankle specialists. During the evaluation, results were included in a data collection sheet as follows: 1) Yes: three criteria were present, 2) I don´t know: two criteria present, and 3) No: no criteria. The intraobserver agreement was calculated with kappa coefficient while the interobserver agreement was calculated with the G-string program. The statistical analysis was performed on the Yes result with the three criteria. Results: Kappa coefficient for intraobserver agreement was 0.2 to 0.5. The interobserver agreement was on average 54%. Conclusion: Radiographs alone are not reliable enough for distinguishing complete femoral fractures related to bisphosphonates.

Keywords : Subtrochanteric; Diaphyseal; Atypical; Femur fractures; Biphosphonates; Alendronate.

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