Endocrine Abstracts

JOINT1794

Pseudofractures are atraumatic radiolucencies resulting from compromised bone mineralization that are often associated with poor clinical outcomes in patients with metabolic bone disorders. The incidence, clinical course of healing, and risk of recurrence of pseudofractures are not well characterized, in no small part because pseudofractures and fractures are commonly reported under the general term “fractures” despite underlying pathophysiologic differences. Accordingly, this report proposes a grading scale to specifically assess pseudofractures. The grading scale was developed based on our clinical experience in treating femoral pseudofractures. The proposed circular taxonomy includes 4 radiographically distinct stages that include an unreactive initial Breach (Stage 1), appearance of a visible Beak (Stage 2) and a rounded Bump (Stage 3), and formation of a Bridge (Stage 4) across the interline. The loop closes at Stage 0, indicating absence of any radiographic hallmarks of a pseudofracture, either because a clinical suspicion does not have a radiologic correlate or because healing and remodeling are complete without residuals. These stages may correspond to a sequential transformation along the course of pseudofracture consolidation, although this requires scientific proof, and stagnation or relapse may occur at any stage. The stages should be further indicated by adding a “d” to the score for dislocation or an “s” for when the situation is clinically stable, meaning no pain and full weight-bearing because of surgical stabilization or sustainable cortical bridging (typically in Stage 4 or 0 [consolidation]). The scale may be used for any pseudofracture regardless of the anatomical site or underlying etiology. The proposed Breach–Beak–Bump–Bridge (4B) concept can be used as a tool in clinical practice to assess pseudofractures over time and to improve specificity and clarity in communication of these findings.