{"id":"https://openalex.org/W7204166385","doi":"https://doi.org/10.1097/corr.0000000000004101","title":"Can Orthopaedic Oncologists Agree on What Is and Is Not a Pathologic Fracture?","display_name":"Can Orthopaedic Oncologists Agree on What Is and Is Not a Pathologic Fracture?","publication_year":2026,"publication_date":"2026-08-25","ids":{"openalex":"https://openalex.org/W7204166385","doi":"https://doi.org/10.1097/corr.0000000000004101","pmid":"https://pubmed.ncbi.nlm.nih.gov/42641000"},"language":"en","primary_location":{"id":"doi:10.1097/corr.0000000000004101","doi":"https://doi.org/10.1097/corr.0000000000004101","is_oa":false,"landing_page_url":"https://doi.org/10.1097/corr.0000000000004101","pdf_url":null,"source":{"id":"https://openalex.org/S191421250","display_name":"Clinical Orthopaedics and Related Research","issn_l":"0009-921X","issn":["0009-921X","1528-1132"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","doyens","jufo-2","ki-jl-2","medline","norway-2"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Clinical Orthopaedics &amp; Related Research","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5119523500","display_name":"Arianna Dalamaggas","orcid":"https://orcid.org/0000-0002-9485-0668","observed_orcids":["https://orcid.org/0000-0002-9485-0668"]},"institutions":[{"id":"https://openalex.org/I126307644","display_name":"University of Iowa","ror":"https://ror.org/036jqmy94","country_code":"US","type":"education","lineage":["https://openalex.org/I126307644"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Arianna Dalamaggas","raw_affiliation_strings":["University of Iowa, North Liberty, IA, USA"],"raw_orcid":"https://orcid.org/0000-0002-9485-0668","affiliations":[{"raw_affiliation_string":"University of Iowa, North Liberty, IA, USA","institution_ids":["https://openalex.org/I126307644"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5109315772","display_name":"A Grothe","orcid":"https://orcid.org/0009-0000-0788-0256","observed_orcids":["https://orcid.org/0009-0000-0788-0256"]},"institutions":[{"id":"https://openalex.org/I126307644","display_name":"University of Iowa","ror":"https://ror.org/036jqmy94","country_code":"US","type":"education","lineage":["https://openalex.org/I126307644"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Abigail Grothe","raw_affiliation_strings":["University of Iowa, North Liberty, IA, USA"],"raw_orcid":"https://orcid.org/0009-0000-0788-0256","affiliations":[{"raw_affiliation_string":"University of Iowa, North Liberty, IA, USA","institution_ids":["https://openalex.org/I126307644"]}]},{"author_position":"middle","author":{"id":null,"display_name":"Yumeng Gao","orcid":"https://orcid.org/0009-0000-8171-8011","observed_orcids":["https://orcid.org/0009-0000-8171-8011"]},"institutions":[{"id":"https://openalex.org/I126307644","display_name":"University of Iowa","ror":"https://ror.org/036jqmy94","country_code":"US","type":"education","lineage":["https://openalex.org/I126307644"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Yumeng Gao","raw_affiliation_strings":["University of Iowa, North Liberty, IA, USA"],"raw_orcid":"https://orcid.org/0009-0000-8171-8011","affiliations":[{"raw_affiliation_string":"University of Iowa, North Liberty, IA, USA","institution_ids":["https://openalex.org/I126307644"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5148093652","display_name":"Felsafa Wodajo","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210122908","display_name":"Virginia Cancer Specialists","ror":"https://ror.org/03tbabt10","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210122908"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Felsafa Wodajo","raw_affiliation_strings":["Virginia Cancer Specialists, Fairfax, VA, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Virginia Cancer Specialists, Fairfax, VA, USA","institution_ids":["https://openalex.org/I4210122908"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5023229467","display_name":"Nicholas S. Tedesco","orcid":"https://orcid.org/0000-0002-2110-383X","observed_orcids":["https://orcid.org/0000-0002-2110-383X"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Nicholas Tedesco","raw_affiliation_strings":["Samaritan Medical Group, Corvallis, OR, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Samaritan Medical Group, Corvallis, OR, USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5089822117","display_name":"Adam Scott Levin","orcid":"https://orcid.org/0000-0003-0450-7821","observed_orcids":["https://orcid.org/0000-0003-0450-7821"]},"institutions":[{"id":"https://openalex.org/I145311948","display_name":"Johns Hopkins University","ror":"https://ror.org/00za53h95","country_code":"US","type":"education","lineage":["https://openalex.org/I145311948"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Adam Levin","raw_affiliation_strings":["Johns Hopkins University, Baltimore, MD, USA"],"raw_orcid":"https://orcid.org/0000-0003-0450-7821","affiliations":[{"raw_affiliation_string":"Johns Hopkins University, Baltimore, MD, USA","institution_ids":["https://openalex.org/I145311948"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5089115266","display_name":"Benjamin James Miller","orcid":"https://orcid.org/0000-0002-9319-1795","observed_orcids":["https://orcid.org/0000-0002-9319-1795"]},"institutions":[{"id":"https://openalex.org/I126307644","display_name":"University of Iowa","ror":"https://ror.org/036jqmy94","country_code":"US","type":"education","lineage":["https://openalex.org/I126307644"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Benjamin J. Miller","raw_affiliation_strings":["University of Iowa, North Liberty, IA, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of Iowa, North Liberty, IA, USA","institution_ids":["https://openalex.org/I126307644"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":3,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.71613192,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T12108","display_name":"Management of metastatic bone disease","score":0.9394999742507935,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T12108","display_name":"Management of metastatic bone disease","score":0.9394999742507935,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10975","display_name":"Bone Tumor Diagnosis and Treatments","score":0.025299999862909317,"subfield":{"id":"https://openalex.org/subfields/2745","display_name":"Rheumatology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10658","display_name":"Bone fractures and treatments","score":0.01590000092983246,"subfield":{"id":"https://openalex.org/subfields/2713","display_name":"Epidemiology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/pathological-fracture","display_name":"pathological fracture","score":0.9810000061988831},{"id":"https://openalex.org/keywords/bone-metastases","display_name":"bone metastasis","score":0.8339999914169312},{"id":"https://openalex.org/keywords/interobserver-agreement","display_name":"interobserver agreement","score":0.7710000276565552},{"id":"https://openalex.org/keywords/radiological-features","display_name":"radiological features","score":0.5080000162124634},{"id":"https://openalex.org/keywords/bone-erosion","display_name":"bone erosion","score":0.8679999709129333},{"id":"https://openalex.org/keywords/cortical-disruption","display_name":"cortical disruption","score":0.8240000009536743},{"id":"https://openalex.org/keywords/bone-displacement","display_name":"bone displacement","score":0.625},{"id":"https://openalex.org/keywords/fracture-line","display_name":"fracture line","score":0.7089999914169312},{"id":"https://openalex.org/keywords/diagnostic-criteria","display_name":"diagnostic criteria","score":0.32899999618530273},{"id":"https://openalex.org/keywords/interobserver-variability","display_name":"interobserver variability","score":0.4339999854564667},{"id":"https://openalex.org/keywords/treatment-decision-making","display_name":"treatment decision-making","score":0.41100001335144043},{"id":"https://openalex.org/keywords/outcome-measurement","display_name":"outcome measurement","score":0.5580000281333923},{"id":"https://openalex.org/keywords/musculoskeletal-tumors","display_name":"musculoskeletal tumors","score":0.4180000126361847}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9595000147819519},{"id":"https://openalex.org/C2778195839","wikidata":"https://www.wikidata.org/wiki/Q1753467","display_name":"Pathologic fracture","level":2,"score":0.5849999785423279},{"id":"https://openalex.org/C68312169","wikidata":"https://www.wikidata.org/wiki/Q216685","display_name":"Orthopedic surgery","level":2,"score":0.5543000102043152},{"id":"https://openalex.org/C126838900","wikidata":"https://www.wikidata.org/wiki/Q77604","display_name":"Radiology","level":1,"score":0.4767000079154968},{"id":"https://openalex.org/C2778724333","wikidata":"https://www.wikidata.org/wiki/Q14401","display_name":"Kappa","level":2,"score":0.3953000009059906},{"id":"https://openalex.org/C92184847","wikidata":"https://www.wikidata.org/wiki/Q4941579","display_name":"Bone pathology","level":2,"score":0.3926999866962433},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.3596000075340271},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.35600000619888306},{"id":"https://openalex.org/C2776169692","wikidata":"https://www.wikidata.org/wiki/Q4941552","display_name":"Bone disease","level":3,"score":0.3449000120162964},{"id":"https://openalex.org/C61434518","wikidata":"https://www.wikidata.org/wiki/Q932510","display_name":"General surgery","level":1,"score":0.34060001373291016},{"id":"https://openalex.org/C143409427","wikidata":"https://www.wikidata.org/wiki/Q161238","display_name":"Magnetic resonance imaging","level":2,"score":0.3366999924182892},{"id":"https://openalex.org/C3018805424","wikidata":"https://www.wikidata.org/wiki/Q4116663","display_name":"Musculoskeletal disease","level":3,"score":0.30489999055862427},{"id":"https://openalex.org/C1862650","wikidata":"https://www.wikidata.org/wiki/Q186005","display_name":"Physical therapy","level":1,"score":0.30379998683929443},{"id":"https://openalex.org/C19527891","wikidata":"https://www.wikidata.org/wiki/Q1120908","display_name":"Medical physics","level":1,"score":0.301800012588501},{"id":"https://openalex.org/C43893838","wikidata":"https://www.wikidata.org/wiki/Q840545","display_name":"Sports medicine","level":2,"score":0.2994999885559082},{"id":"https://openalex.org/C61863361","wikidata":"https://www.wikidata.org/wiki/Q470749","display_name":"Inter-rater reliability","level":3,"score":0.28630000352859497},{"id":"https://openalex.org/C31601959","wikidata":"https://www.wikidata.org/wiki/Q931309","display_name":"Medical imaging","level":2,"score":0.27900001406669617},{"id":"https://openalex.org/C163864269","wikidata":"https://www.wikidata.org/wiki/Q1107106","display_name":"Cohen's kappa","level":2,"score":0.2750999927520752},{"id":"https://openalex.org/C3020702983","wikidata":"https://www.wikidata.org/wiki/Q68833","display_name":"Fracture treatment","level":2,"score":0.2599000036716461},{"id":"https://openalex.org/C3017722815","wikidata":"https://www.wikidata.org/wiki/Q1483951","display_name":"Malignant disease","level":3,"score":0.25780001282691956},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.25529998540878296},{"id":"https://openalex.org/C36454342","wikidata":"https://www.wikidata.org/wiki/Q245341","display_name":"Radiography","level":2,"score":0.2551000118255615}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.1097/corr.0000000000004101","doi":"https://doi.org/10.1097/corr.0000000000004101","is_oa":false,"landing_page_url":"https://doi.org/10.1097/corr.0000000000004101","pdf_url":null,"source":{"id":"https://openalex.org/S191421250","display_name":"Clinical Orthopaedics and Related Research","issn_l":"0009-921X","issn":["0009-921X","1528-1132"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","doyens","jufo-2","ki-jl-2","medline","norway-2"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Clinical Orthopaedics &amp; Related Research","raw_type":"journal-article"},{"id":"pmid:42641000","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42641000","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Clinical orthopaedics and related research","raw_type":"Journal Article"}],"best_oa_location":null,"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being","score":0.9391000270843506}],"sustainable_development_goals_aurora":[{"id":"https://metadata.un.org/sdg/16","display_name":"Peace, justice, and strong institutions","score":0.5017459988594055}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":8,"referenced_works":["https://openalex.org/W2022266932","https://openalex.org/W2034217069","https://openalex.org/W2164777277","https://openalex.org/W3024994977","https://openalex.org/W3095192788","https://openalex.org/W3121307901","https://openalex.org/W4245825074","https://openalex.org/W4388341855"],"related_works":[],"abstract_inverted_index":{"BACKGROUND:":[0],"Orthopaedic":[1],"oncologists":[2,72,118,385],"have":[3,466,511],"not":[4,77,222,372],"agreed":[5,339,432],"on":[6,16,45,60,74,267,272,433,449,485,489],"a":[7,78,93,101,143,147,177,200,225,273,345,354,375,394,398,407,412,424,443,497,501,516],"common":[8,455,467],"definition":[9,22,499],"of":[10,41,54,103,142,146,194,231,258,263,314,327,380,426,451,460,500],"pathologic":[11,55,79,94,178,259,355,376,444,502],"fracture":[12,80,95,226,348,419,445,503],"despite":[13],"abundant":[14],"reports":[15],"diagnosis":[17],"and":[18,30,43,65,112,158,211,247,299,471,480,535],"management.":[19],"A":[20],"standard":[21],"is":[23,35,81,96,462],"important":[24],"for":[25,171,216,254,284,292,304,324,469,496,515,529],"treatment":[26],"decisions,":[27],"outcomes":[28],"assessment,":[29],"administrative":[31],"categorization;":[32],"therefore,":[33],"it":[34],"first":[36,164,294],"necessary":[37],"to":[38,67,90,115,183,207,227,243,278,311,373,465,494,525],"understand":[39],"areas":[40,230,379],"agreement":[42,253,264,309,484],"disagreement":[44,382],"the":[46,125,163,190,195,205,248,255,293,305,325,403,427,434,521],"imaging":[47,85,328,435,486],"findings":[48,436,487,510],"exclusively":[49],"before":[50],"considering":[51],"nonradiologic":[52],"features":[53,86],"fracture.":[56,356,377],"QUESTIONS/PURPOSES:":[57],"(1)":[58,393],"Based":[59],"images":[61,104,341,360,452],"(radiographs,":[62],"CT":[63],"scans,":[64],"MRIs),":[66],"what":[68],"degree":[69],"do":[70],"orthopaedic":[71,88,117,384],"agree":[73],"whether":[75,220,442],"or":[76,121,187,221,235,350,415,421],"present?":[82,97],"(2)":[83,406],"What":[84],"lead":[87],"surgeons":[89],"believe":[91],"that":[92,335,340,453,477,504],"METHODS:":[98],"We":[99,333],"developed":[100],"survey":[102],"from":[105,276,342,402],"20":[106],"patients":[107,343,358],"with":[108,149,153,344,397],"metastatic":[109,150],"bone":[110,151,351,362],"disease":[111],"distributed":[113],"them":[114],"30":[116],"holding":[119],"committee":[120],"leadership":[122],"positions":[123],"in":[124,199,233,386,423,531],"Musculoskeletal":[126],"Tumor":[127],"Society":[128],"(MSTS).":[129],"Images":[130],"were":[131,181,370],"reviewed":[132],"twice,":[133],"at":[134,483],"least":[135],"6":[136],"months":[137],"apart.":[138],"Each":[139],"question":[140,170],"consisted":[141],"PowerPoint":[144,197],"slide":[145],"patient":[148,173],"disease,":[152],"representative":[154],"plain":[155],"radiographs,":[156],"CTs,":[157],"MRIs":[159],"when":[160,390],"available.":[161],"On":[162],"survey,":[165,192,295],"there":[166,176,223,391],"was":[167,224,241,265,287,319,392,446],"only":[168],"one":[169],"each":[172,217],"scenario:":[174],"\"Is":[175],"fracture?\"":[179],"Respondents":[180],"asked":[182,204],"respond":[184],"simply":[185],"\"yes\"":[186],"\"no.\"":[188],"In":[189],"second":[191],"consisting":[193],"same":[196],"slides":[198],"different":[201],"order,":[202],"we":[203],"participants":[206],"provide":[208],"additional":[209],"insight":[210],"rationale":[212],"behind":[213],"their":[214],"decision":[215],"case":[218],"regarding":[219,441],"further":[228,478],"investigate":[229],"differences":[232],"interpretation":[234,388],"assessment.":[236],"The":[237,261,281,316,378],"Fleiss":[238,282,317],"kappa":[239,250,274,283,318],"(\u03ba)":[240],"used":[242],"evaluate":[244],"interrater":[245,285],"agreement,":[246,298],"Cohen":[249],"assessed":[251],"intrarater":[252],"binary":[256],"classification":[257],"fractures.":[260],"strength":[262],"classified":[266],"an":[268,417],"interval":[269],"scale":[270],"based":[271,448,488],"value":[275],"0.0":[277],"1.0.":[279],"RESULTS:":[280],"reliability":[286],"0.54":[288],"(p":[289,301,321],"<":[290,302,322],"0.001)":[291,303,323],"indicating":[296],"moderate":[297,331],"0.64":[300],"second,":[306],"reflecting":[307,330],"substantial":[308],"according":[310],"established":[312],"definitions":[313],"agreement.":[315,332],"0.47":[320],"description":[326],"findings,":[329],"found":[334],"nearly":[336],"every":[337],"surgeon":[338],"complete":[346,367],"visible":[347],"line":[349,420],"displacement":[352],"represented":[353],"Similarly,":[357],"whose":[359],"showed":[361],"erosion":[363],"but":[364,437],"no":[365],"obvious":[366],"cortical":[368,395],"disruption":[369],"determined":[371],"represent":[374],"major":[381],"among":[383],"image":[387],"occurred":[389],"perforation":[396],"soft":[399],"tissue":[400],"component":[401],"underlying":[404],"tumor,":[405],"severely":[408],"compromised":[409],"cortex":[410],"without":[411],"clear":[413,472,498],"discontinuity,":[414],"(3)":[416],"incomplete":[418],"callus":[422],"portion":[425],"cortex.":[428],"CONCLUSION:":[429],"Often":[430],"raters":[431],"drew":[438],"opposite":[439],"conclusions":[440],"present":[447],"sets":[450],"replicate":[454],"clinical":[456,532],"scenarios.":[457],"This":[458,475],"disproportionality":[459],"responses":[461],"too":[463],"great":[464],"language":[468],"communication":[470],"surgical":[473],"indications.":[474],"indicates":[476],"review":[479],"consensus":[481,518],"aimed":[482],"these":[490],"data":[491],"are":[492],"needed":[493],"allow":[495],"can":[505],"be":[506],"universally":[507],"applied.":[508],"Our":[509],"stimulated":[512],"early":[513],"work":[514],"multispecialty":[517],"project":[519],"within":[520],"MSTS,":[522],"which":[523],"aims":[524],"classify":[526],"skeletal":[527],"lesions":[528],"use":[530],"communication,":[533],"research,":[534],"registries.":[536],"LEVEL":[537],"OF":[538],"EVIDENCE:":[539],"Level":[540],"IV,":[541],"diagnostic":[542],"study.":[543]},"counts_by_year":[],"updated_date":"2026-09-27T08:07:27.782135","created_date":"2026-08-26T00:00:00"}
