Atipik femur kırığı

Özet

Atipik femur kırığı, minimal travma ile subtrokanterik bölge veya femur şaftında gelişen, çoğunlukla stres kırığı morfolojisi taşıyan özel bir kırık örüntüsüdür. Stres kırıklarında MRG en duyarlı ve özgül görüntüleme yöntemidir; atipik femur kırığı çizgisi lateral korteksten başlar ve büyük ölçüde transvers seyreder, mediale ilerlerken oblikleşebilir, tam kırıkta iki korteksi geçebilir ve parçalanma yok ya da minimaldir. Tamamlanmamış atipik femur kırığı yalnız lateral korteksi tutar; karşı femurda da benzer bir kırık olup olmadığı görüntülemeyle incelenmelidir. Bu örüntünün sıradan osteoporotik femur şaft kırıklarından ayrılması, atipik kırıkların doğru tanınması açısından önemlidir.

Faz ve pencere

Kontrastsız tanısal

Lateral femur korteksinden başlayan, başlangıçta transvers ve mediale ilerlerken kısa oblik olabilen kırık çizgisi; lokal kortikal kalınlaşma ve periostal/endosteal çıkıntı ile birlikte değerlendirilir. Atipik femur kırığı değerlendirmesinde lateral korteksten başlayan transvers çizgi ve kırık yerindeki fokal kortikal kalınlaşma aranır.

Kemik algoritması tanısal

Aksiyel ve koronal-sagittal kemik rekonstrüksiyonları lateral korteks başlangıcını, yalnız lateral korteksi tutan inkomplet hattı veya iki korteksi geçen tam hattı, medial spike'ı ve minimal parçalanmayı gösterir. Görüntü alanı tüm femur şaftı ile karşı tarafı içermelidir.

Önerilen pencereler: Kemik (G 1800 / M 400).

BT bulguları

• Lateral korteks başlangıcı — kırık çizgisi lateral korteksten çıkar ve esas olarak transvers seyreder.
• Kortikal beaking/flaring — kırık başlangıcında fokal periostal veya endosteal kalınlaşma ve çıkıntı.
• İnkomplet kırık — hat lateral korteksle sınırlı kalır; medial korteks boyunca tam geçiş yoktur.
• Tam kırık — çizgi femurun iki korteksini geçer ve transvers/kısa oblik biçimde uzanır.
• Medial spike — tam kırıkta medial kortekste sivri üçgensi fragman ucu görülebilir.
• Az parçalı morfoloji — belirgin parçalanma yoktur ya da minimaldir; geniş kelebek fragmanlı spiral görünüm tipik değildir.
• Karşı femurda stres reaksiyonu — benzer lateral kortikal kalınlaşma veya inkomplet çizgi eşlik edebilir.

Ölçütler ve sınıflamalar

ASBMR 2013 tanımı için gerekli majör özellik sayısı

5 majör özelliğin en az 4'ü

ASBMR 2013 atipik femur kırığı vaka tanımı

Yerleşim, küçük travma, lateral korteksten başlayan transvers/kısa oblik çizgi, tam veya inkomplet kortikal uzanım, parçalanmanın olmaması/minimal olması ve lokal lateral korteks kalınlaşması birlikte değerlendirilir; tanım için beş majör özelliğin en az dördü gerekir. Periprostetik kırıklar ASBMR atipik femur kırığı vaka tanımının dışındadır.

Normalde

Atipik femur kırığında lateral kortekste kırık yerinde fokal periostal veya endosteal kalınlaşma (beaking) görülebilir; bu bulgu tek başına kırık hattı bulunduğunu göstermez. Karşı femurda benzer bir atipik kırık olup olmadığını ve varsa kırıkların femur boyunca benzer seviyede yerleşip yerleşmediğini değerlendirin.

Ayırıcı tanı

Osteoporotik femur şaft kırıklarından ayrımda, atipik femur kırığının lateral korteksten başlayan transvers çizgisi ve parçalanmanın yokluğu ya da minimal olması dikkate alınır.

Femur boyun kırığı

kırık femur boynundadır, subtrokanterik-şaft diyafiz bölgesinde değildir.

Metastatik patolojik kırık

litik veya sklerotik lezyon eşlik edebilir; atipik kırık ise öncelikle uzun süreli antiresorptif terapi (bisfosfonat, denozumab) ile ilişkilendirilir.

Paget hastalığına bağlı kırık

kortikal ve trabeküler yeniden yapılanma daha yaygın olabilir; eşlik eden kemik morfolojisi değerlendirilir.

Stres reaksiyonu olmadan kortikal kalınlaşma

fokal beaking benzeri kalınlaşma vardır ancak kırık çizgisi izlenmez; klinik ve karşı tarafla birlikte tarif edilir.

Tuzaklar

• Atipik kırığı tanımlarken ilaç öyküsünü morfolojinin yerine koymayın; vaka tanımı görüntüleme ve klinik majör özelliklerin birleşimine dayanır.
• Sadece tek taraflı BT alanı kırılırsa karşı taraftaki inkomplet stres lezyonu dışarıda kalır; mümkünse her iki femur şaftını görüntü alanına alın.
• Lateral kortikal kalınlaşma tek başına kırık hattı değildir; çizgi yoksa bunu tamamlanmış kırık olarak adlandırmayın.
• Medial spike'ı herhangi bir medial kortikal düzensizlikle karıştırmayın; tam kırık çizgisinin medial korteksi geçmesiyle ilişkisini doğrulayın.

Kendini dene

1. Minimal travma sonrası femur şaftında lateral korteksten başlayan transvers hat, lokal beaking ve medial spike görülüyor. En olası kırık örüntüsü nedir?

   • Atipik femur kırığı
   • Spiral osteoporotik kırık
   • Metastatik kırık
   • Femur boyun kırığı
   Cevabı göster

   Atipik femur kırığı. Lateral korteks başlangıcı, transvers seyir, fokal beaking ve medial spike atipik femur kırığı morfolojisini destekler. Spiral osteoporotik kırık farklı hat yönü gösterir; metastatik kırıkta lezyon aranır, femur boyun kırığı farklı anatomik düzeydedir.

2. ASBMR tanımına göre inkomplet atipik femur kırığı hangi korteksi tutar?

   • Yalnız lateral korteksi
   • Her iki korteksi
   • Yalnız medial korteksi
   • Femur boyun korteksini
   Cevabı göster

   Yalnız lateral korteksi. ASBMR tanımında inkomplet atipik femur kırığı yalnız lateral korteksi tutar.

Kaynaklar

Bu sayfadaki 41 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Current Understanding of Epidemiology, Pathophysiology, and Management of Atypical Femur Fracturespmc.ncbi.nlm.nih.gov
2. Stress fracture of the pelvis and lower limbs including atypical femoral fractures—a reviewpmc.ncbi.nlm.nih.gov
3. Current imaging techniques in osteoporosis.pubmed.ncbi.nlm.nih.gov
4. Atypical periprosthetic femoral fractures of the hip: A PRISMA compliant systematic review.pubmed.ncbi.nlm.nih.gov
5. Periprosthetic Atypical Femoral Fractures in Patients on Long-term Bisphosphonates: A Multicenter Retrospective Review.pubmed.ncbi.nlm.nih.gov
6. Clinical experience with microindentation in vivo in humans.pubmed.ncbi.nlm.nih.gov
7. Atypical Femoral Fracture: 2015 Position Statement of the Korean Society for Bone and Mineral Research.pubmed.ncbi.nlm.nih.gov
8. The enigma of atypical femoral fractures: A summary of current knowledge.pubmed.ncbi.nlm.nih.gov
9. Incomplete atypical femoral fractures: assessing the diagnostic utility of DXA by extending femur length.pubmed.ncbi.nlm.nih.gov
10. PTH(1-34) Treatment Increases Bisphosphonate Turnover in Fracture Repair in Rats.pubmed.ncbi.nlm.nih.gov
11. Bilateral atypical femoral fractures: how much symmetry is there on imaging?pubmed.ncbi.nlm.nih.gov
12. Atypical incomplete femoral fractures in asymptomatic patients on long term bisphosphonate therapy.pubmed.ncbi.nlm.nih.gov
13. [Atypical femoral fractures associated with long-term treatment with bisphosphonates].pubmed.ncbi.nlm.nih.gov
14. Imaging of the Acutely Injured Hip.pubmed.ncbi.nlm.nih.gov
15. Efficacy and safety of denosumab de‑escalation in giant cell tumor of bone.pubmed.ncbi.nlm.nih.gov
16. Morphological profile of atypical femoral fractures: age-related changes to the cross-sectional geometry of the diaphysis.pubmed.ncbi.nlm.nih.gov
17. Bisphosphonate-Related Pathological Femoral Fracture in a Child with ACTG2-Related Intestinal Failure and Metabolic Bone Disease: A Case Report.pubmed.ncbi.nlm.nih.gov
18. Radiological Assessment of Atypical Femoral Fractures: A 10-Year Experience Across Two Centres.pubmed.ncbi.nlm.nih.gov
19. Bisphosphonate-Associated Atypical Femoral Fractures: A Description of Surgical Techniques in the Revision Fixation Setting With an Emphasis on Avoiding Varus Malalignment: A Two-Case Report.pubmed.ncbi.nlm.nih.gov
20. Case review of 3 patients with musculoskeletal manifestation of human immunodeficiency virus and highly active antiretroviral therapy in the form of osteopenia and insufficiency fractures.pubmed.ncbi.nlm.nih.gov
21. Magnetic resonance imaging (MRI) vs. computed tomography (CT) in the diagnosis and classification of spondylolysis and spondylolisthesis-a narrative review.pubmed.ncbi.nlm.nih.gov
22. Imaging approach to deposition and neurogenic arthropathies.pubmed.ncbi.nlm.nih.gov
23. The Importance of Closed Reduction and Internal Fixation done with Intramedullary Implants in Pathological Fractures - A Case Series.pubmed.ncbi.nlm.nih.gov
24. Bisphosphonate-Related Atypical Femoral Fractures: A Comprehensive Review.pubmed.ncbi.nlm.nih.gov
25. Atypical Femoral Fracture Secondary to Long-Term Bisphosphonate Use: A Case Report.pubmed.ncbi.nlm.nih.gov
26. Total laparoscopic radical hysterectomy for cervical cancer in prolapsed uterus.pubmed.ncbi.nlm.nih.gov
27. Atypical femoral fracture: The periprosthetic variant about two cases without bisphosphonate use.pubmed.ncbi.nlm.nih.gov
28. Diagnostic challenges in an adult patient with Fanconi Anemia: Neuroinflammatory Syndrome (FANS) intertwined with infectious processes.pubmed.ncbi.nlm.nih.gov
29. Inflammatory mass or malignancy? The radiology of fish bone phlegmon: a review of 3 cases.pubmed.ncbi.nlm.nih.gov
30. Unilateral Orbital Lymphomas: A Structured Multidisciplinary Workflow for Diagnosis and Management.pubmed.ncbi.nlm.nih.gov
31. Case Report: Combined posterolateral and direct anterior approaches for total hip arthroplasty in osteonecrosis of the femoral head with a rare massive osteophyte with literature review.pubmed.ncbi.nlm.nih.gov
32. What's New in Osteogenesis Imperfecta.pubmed.ncbi.nlm.nih.gov
33. Comparing incomplete atypical femur fractures in patients with or without bisphosphonate treatment: radiography and bone morphology in a retrospective study of 19 cases.pubmed.ncbi.nlm.nih.gov
34. Mortality following atypical femoral fractures in men.pubmed.ncbi.nlm.nih.gov
35. Imaging of pediatric musculoskeletal trauma: Age-specific considerations and challenges.pubmed.ncbi.nlm.nih.gov
36. Impact of Prolonged Bisphosphonate Therapy on Atypical Femoral Fractures: Insights from a Single-Center Experience.pubmed.ncbi.nlm.nih.gov
37. Radiographic Evolution of Contralateral Asymptomatic Incomplete Atypical Femoral Fractures in Autoimmune Disease Patients.pubmed.ncbi.nlm.nih.gov
38. Non-union after bisphosphonate-associated atypical femoral fractures: a review of the current literature.pubmed.ncbi.nlm.nih.gov
39. Intraosseous tumours of the knee.pubmed.ncbi.nlm.nih.gov
40. Senescence-driven osteonecrosis of the femoral head in the elderly-a distinct pathophysiological entity.pubmed.ncbi.nlm.nih.gov
41. Lateral fixation: an alternative surgical approach in the prevention of complete atypical femoral fractures.pubmed.ncbi.nlm.nih.gov
42. Bilateral atypical femoral fractures following unsupervised long-term alendronate use: a case report.pubmed.ncbi.nlm.nih.gov
43. Isolated Atypical Pedicle Stress Fractures in Patients on Prolonged Bisphosphonate Therapy: Report of Two Cases and a Literature-Based Proposal for Diagnostic Criteria.pubmed.ncbi.nlm.nih.gov
44. Genetic Disorders of Bone or Osteodystrophies of Jaws-A Review.pubmed.ncbi.nlm.nih.gov
45. Safe surgical technique for associated acetabular fractures.pubmed.ncbi.nlm.nih.gov
46. International Harmonization of Nomenclature and Diagnostic Criteria (INHAND): Non-proliferative and Proliferative Lesions of the Non-human Primate ( M. fascicularis ).pubmed.ncbi.nlm.nih.gov
47. Commentary: an eye on PET quantification.pubmed.ncbi.nlm.nih.gov
48. Bilateral Femoral Shaft Fractures Associated with Long-Term Bisphosphonate Therapy.pubmed.ncbi.nlm.nih.gov
49. Bone Structure and Turnover Status in Postmenopausal Women with Atypical Femur Fracture After Prolonged Bisphosphonate Therapy.pubmed.ncbi.nlm.nih.gov
50. Epidemiology, Pathophysiology and Management of Atypical Femur Fractures: an Update.pubmed.ncbi.nlm.nih.gov
51. Asian Federation of Osteoporosis Societies 2025 consensus on atypical femoral fractures in patients with osteoporosis.pubmed.ncbi.nlm.nih.gov
52. Glossary of terms for musculoskeletal radiology.pubmed.ncbi.nlm.nih.gov
53. International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines.pubmed.ncbi.nlm.nih.gov
54. Isolated Lesser Trochanter Fractures in Adults: A Systematic Review of Malignant, Infectious, and Benign Etiologies.pubmed.ncbi.nlm.nih.gov
55. Management of Hip Arthroplasty for Intertrochanteric Fractures Under the Treatment Concept of Periprosthetic Fractures.pubmed.ncbi.nlm.nih.gov
56. Biochemical and Demographical Differences in Atypical vs. Typical Femoral Fractures: A 10-Year Experience Across Two Centers.pubmed.ncbi.nlm.nih.gov
57. Internal-locking intramedullary nails (talons, claws, wings, wedge-locks, endopins): a mechanics-guided scoping review of designs, failure signatures, and technique imperatives.pubmed.ncbi.nlm.nih.gov
58. Does Cephalomedullary Nail Design Influence Risk of Varus Collapse in Subtrochanteric Femur Fractures?pubmed.ncbi.nlm.nih.gov
59. Risk factors for atypical femur fractures with and without bisphosphonate treatment: a national nested case-control study.pubmed.ncbi.nlm.nih.gov
60. Surgically Treated Benign Bone Tumors and Tumor-like Conditions in the Pediatric Population-A 10-Year Institutional Experience.pubmed.ncbi.nlm.nih.gov
61. Giant Cell Tumor of Bone: Biology, Pathophysiology, and Histopathology in the Era of H3F3A.pubmed.ncbi.nlm.nih.gov
62. Primary leiomyosarcoma of the bone: a case report.pubmed.ncbi.nlm.nih.gov
63. Bone aging: a paradigm of multiscale degeneration and targeted rejuvenation.pubmed.ncbi.nlm.nih.gov
64. Postmenopausal Osteoporosis: From Molecular Pathways to Therapeutic Targets-A Mechanism-to-Practice Framework Integrating Pharmacotherapy, Fall Prevention, and Adherence into Patient-Centered Care.pubmed.ncbi.nlm.nih.gov
65. Atypical Fracture From Bisphosphonate Use in Hypophosphatasia With Improved Bone Response to Teriparatide Therapy.pubmed.ncbi.nlm.nih.gov
66. Sequential stress fractures of the ulna and radius in a patient with neurofibromatosis type 1: A case report.pubmed.ncbi.nlm.nih.gov
67. Atypical Femoral Fractures in Adult Patients with Classical Osteogenesis Imperfecta.pubmed.ncbi.nlm.nih.gov
68. Characteristics and Risk Factors of Atypical Periprosthetic Femoral Fractures Following Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.pubmed.ncbi.nlm.nih.gov
69. Effect of bisphosphonates on the risk of surgical site infection after anterior cervical discectomy and fusion (ACDF) in postmenopausal women with osteoporosis.pubmed.ncbi.nlm.nih.gov
70. Magnetic resonance imaging of the wrist and hand.pubmed.ncbi.nlm.nih.gov
71. Clinical practice guidelines for the care of girls and women with Turner syndrome.pubmed.ncbi.nlm.nih.gov
72. Femoral diaphyseal fatigue stress fracture in an older adult male with normal bone mineral density.pubmed.ncbi.nlm.nih.gov
73. Association of knee osseous morphometric parameters with degeneration and tear of the discoid lateral meniscus: a cross-sectional quantitative MRI study.pubmed.ncbi.nlm.nih.gov
74. Evaluation of the effect of eccentric nailing on femoral diaphyseal union delay.pubmed.ncbi.nlm.nih.gov
75. Surgical and Pharmacological Management of Periprosthetic Atypical Femoral Fractures: A Narrative Literature Review.pubmed.ncbi.nlm.nih.gov
76. Current concepts in the management of bisphosphonate associated atypical femoral fractures.pubmed.ncbi.nlm.nih.gov
77. Extravertebral low back pain: a scoping review.pubmed.ncbi.nlm.nih.gov
78. Long-term safety and effectiveness of the "OptEase" vena cava filter.pubmed.ncbi.nlm.nih.gov
79. Low-energy atypical femoral shaft and ipsilateral neck fracture: a rare association.pubmed.ncbi.nlm.nih.gov
80. Proximal femoral reconstruction for failed internal fixation of a bisphosphonate-related femur fracture.pubmed.ncbi.nlm.nih.gov
81. Etiological, clinical characteristics, and treatment of atypical femur fracture: A retrospective study.pubmed.ncbi.nlm.nih.gov
82. Reconstruction with megaprosthesis for recurrent nonunion of an atypical periprosthetic femoral fracture in an elderly patient.pubmed.ncbi.nlm.nih.gov
83. Occult cement plug causing femoral canal obstruction during nailing after TKA: a case report.pubmed.ncbi.nlm.nih.gov
84. Intra-articular Osteoid Osteoma of the Femoral Neck Mimicking Inflammatory Hip Disease: A Case Report and Review of the Literature.pubmed.ncbi.nlm.nih.gov
85. Angular and Rotational Lower Limb Alignment Variations in Children: Practical Guidance for Paediatricians.pubmed.ncbi.nlm.nih.gov
86. High-grade leiomyosarcoma of the common femoral vein masquerading as a femoral artery aneurysm in an elderly patient: A diagnostic challenge.pubmed.ncbi.nlm.nih.gov
87. Direct Assessment of Rabbit Cortical Bone Basic Multicellular Unit Longitudinal Erosion Rate: A 4D Synchrotron-Based Approach.pubmed.ncbi.nlm.nih.gov
88. Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography.pubmed.ncbi.nlm.nih.gov
89. Atraumatic fractures of the femur.pubmed.ncbi.nlm.nih.gov
90. The first reported case of Atypical Femoral Fracture caused by daily ibandronate prescribed for bone metastases in breast cancer.pubmed.ncbi.nlm.nih.gov
91. Deep learning and hybrid architectures for atypical and complex bone fracture diagnosis: a systematic review of performance and clinical validity.pubmed.ncbi.nlm.nih.gov
92. Development and validation of a deep learning-based automatic detection and classification model for femoral neck fractures using hip imaging: a retrospective multicenter diagnostic study.pubmed.ncbi.nlm.nih.gov
93. An analysis of the imaging features and diagnostic value of osteoid osteoma on DR, CT, and MRI.pubmed.ncbi.nlm.nih.gov
94. Diagnostic Dilemma in a Distal Femoral Intramedullary Lesion: Enchondroma Mimicking Low-Grade Chondrosarcoma with Discordant Biopsy Findings: A Case Report.pubmed.ncbi.nlm.nih.gov
95. Time-Course Evaluation of the In Vivo Resorption Process of Calcium Phosphates/Poly(lactide-<i>co</i>-glycolide) Composites Using Radiological Imaging and Histology.pubmed.ncbi.nlm.nih.gov
96. A Case Report of a Symptomatic Atrophy and Osteonecrosis of the Femoral Diaphysis Induced by Internal Plate Fixation of a Periprosthetic Fracture.pubmed.ncbi.nlm.nih.gov
97. Unveiling a Silent Bone Lesion: Pathological Fracture in a Child With Non-Ossifying Fibroma.pubmed.ncbi.nlm.nih.gov
98. 2.5-mm articulated endoluminal forceps using a compliant mechanism.pubmed.ncbi.nlm.nih.gov
99. Atypical Bilateral Proximal Femoral Focal Deficiency: A Case Report and Review of Literature.pubmed.ncbi.nlm.nih.gov
100. Piezo1-mediated mechanotransduction in bone formation and fracture repair.pubmed.ncbi.nlm.nih.gov
101. Pathophysiology of Femoral Fractures in Hypophosphatasia.pubmed.ncbi.nlm.nih.gov
102. The role of the fracture liaison service in the prevention of atypical femoral fractures.pubmed.ncbi.nlm.nih.gov
103. Prevalence of incomplete atypical femoral fractures using single energy absorptiometry after long-term anti-resorptive therapy.pubmed.ncbi.nlm.nih.gov
104. Updated practice guideline for dual-energy X-ray absorptiometry (DXA).pubmed.ncbi.nlm.nih.gov
105. Osteoid osteoma of the femoral neck as a rare cause of hip pain in a 50-year-old male: A case report.pubmed.ncbi.nlm.nih.gov
106. Imaging features and differential diagnosis of benign osseous cystic lesions: Aneurysmal bone cyst versus femoral neck herniation pit.pubmed.ncbi.nlm.nih.gov
107. Tumor survivors' musculoskeletal health assessment: advances in imaging biomarkers for cancer treatment-related sequelae.pubmed.ncbi.nlm.nih.gov
108. Acetabular superior wall fractures: a distinct acetabular fracture entity.pubmed.ncbi.nlm.nih.gov
109. Metastatic Retroperitoneal Rhabdomyosarcoma in a Child: A Case Report Highlighting the Role of Imaging in Diagnosis, Staging, and Follow-Up.pubmed.ncbi.nlm.nih.gov
110. Atypical Femur Fractures Without Bisphosphonate Exposure (AFFwB): A Retrospective Report of 21 Cases.pubmed.ncbi.nlm.nih.gov
111. Biomechanical Study of the Preventive Effect of Different Cephalomedullary Fixation Methods on the Occurrence of Femoral Neck Fractures in Osteoporotic Femurs.pubmed.ncbi.nlm.nih.gov
112. Rare Presentation of Atypical Fractures in a Patient of Autoimmune Polyglandular Syndrome - A Case Report.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.