BET 2: CT versus MRI for occult hip fractures

2018 ◽  
Vol 35 (10) ◽  
pp. 645-647 ◽  
Author(s):  
Bernard A Foex ◽  
Anna Russell
Keyword(s):  
Hip Fracture ◽  
Ct Scan ◽  
Hip Fractures ◽  
Clinical Suspicion ◽  
First Line ◽  
Bottom Line ◽  
X Ray ◽  
Occult Hip Fracture ◽  
Study Type ◽  
Occult Hip Fractures

A short-cut review was carried out to establish whether CT or MRI is better at detecting an occult hip fracture. Six studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that CT is a valid first-line investigation for a suspected plain X-ray occult hip fracture. If clinical suspicion remains after a negative CT scan, then MRI should be used.

scholarly journals Bilateral occult hip fracture

CJEM ◽  
2012 ◽  
Vol 14 (06) ◽  
pp. 372-377 ◽  
Author(s):  
Willis B. Grad ◽  
Nicholas M. Desy
Keyword(s):  
Emergency Department ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Plain Radiographs ◽  
Diagnostic Studies ◽  
Acute Injuries ◽  
Occult Hip Fracture ◽  
Occult Hip Fractures

ABSTRACTOne of the most common acute injuries seen in the emergency department is the hip fracture. This injury is usually diagnosed by plain radiographs, however these fractures are sometimes not obviously apparent. Occult hip fractures present a pitfall for emergency department physicians. We present a case of a patient who sustained bilateral occult hip fractures. We review the epidemiology of the condition, examine what diagnostic studies are available that may help the physician avoid missing the occult hip fracture and what the literature tells us about the utility of each of these modalities. The prognosis of the occult hip fracture along with options for treatment is also discussed.

scholarly journals Use of Multislice CT for Investigation of Occult Geriatric Hip Fractures and Impact on Timing of Surgery

2019 ◽  
Vol 10 ◽  
pp. 215145931882121
Author(s):  
John Williams ◽  
Felix Allen ◽  
Marta Kedrzycki ◽  
Yathish Shenava ◽  
Renu Gupta
Keyword(s):  
Hip Fracture ◽  
Computerized Tomography ◽  
Hip Fractures ◽  
Multislice Ct ◽  
Clinical Excellence ◽  
Timing Of Surgery ◽  
First Line ◽  
Initial Radiograph ◽  
Magnetic Resonance Imaging Mri ◽  
Occult Hip Fractures

Introduction: The National Institute of Health and Clinical Excellence guidelines in the United Kingdom recommend magnetic resonance imaging (MRI) as the first-line investigation for radiographically occult hip fractures, if available within 24 hours. In our department, however, multislice computerized tomography (MSCT) is instead used as a first-line investigation due to significant delays associated with obtaining MRI. Our aim was to determine the validity and practicality of MSCT for diagnosis of occult hip fractures and its impact on timing of surgery. Materials and Methods: We retrospectively analyzed medical records and imaging for consecutive patients who underwent MSCT to investigate occult hip fractures between January 2014 and October 2016. We reviewed subsequent imaging and reattendances for patients with negative MSCT to exclude initially missed fractures. Results: Two hundred six patients underwent MSCT to investigate occult hip fracture during the study period. Hip fractures were identified in 59 patients, comprising 35 (59.3%) subcapital, 12 (20.0%) intertrochanteric, 8 (13.6%) transcervical, and 4 (6.8%) basicervical fractures. One missed hip fracture was identified: a patient with a negative MSCT was further investigated with MRI that demonstrated acute subcapital hip fracture. Multislice computerized tomography was obtained within 24 hours of initial radiograph in 145 (70.4%) patients. A total of 44.5% of occult hip fractures had surgery within the nationally recommended 36 hours of admission (hospital average for all hip fractures was 76.4% over the same period). Discussion and Conclusions: Multislice computerized tomography is a pragmatic approach to investigate the majority of occult hip fractures in a timely manner and minimize associated delay to surgery. However it cannot completely exclude the diagnosis, especially in abnormal anatomy. The lack of a true gold standard comparison (ie, MRI) means a true sensitivity and specificity cannot be calculated, although can be cautiously estimated by lack of subsequent reattendance or investigation. Further prospective randomized CT versus MRI trials are required.

scholarly journals Occult hip fracture diagnosed by MRI scan after inconclusive X-ray and CT scan

2015 ◽  
Vol 6 (7) ◽  
pp. 444
Author(s):  
Bogdan Deleanu ◽  
Radu Prejbeanu ◽  
Florin Birsasteanu ◽  
Dinu Vermesan ◽  
Liviu-Ionut Micle ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Ct Scan ◽  
Mri Scan ◽  
X Ray ◽  
Occult Hip Fracture

scholarly journals The use of MRI and CT in Imaging Occult Hip Fractures

2014 ◽  
Vol 20 (4) ◽  
pp. 207-210
Author(s):  
B. Obadă ◽  
Al. O. Șerban ◽  
V. Botnaru ◽  
Al. Valcu
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Inclusion Criteria ◽  
Daily Lives ◽  
Fracture Characterization ◽  
Orthopedic Injury ◽  
Bone Edema ◽  
Occult Hip Fracture ◽  
Displaced Fracture ◽  
Occult Hip Fractures

Abstract Diagnosis of hip fractures is particularly important due to the high dependence on the integrity of this structure for people to function in their daily lives. Left unrecognized, patients face increasing morbidity and mortality as time from the original injury lengthens. A delay of just 2 days in surgical treatment for an acute hip fracture doubles mortality. In addition, an unrecognized non-displaced fracture may displace, requiring surgery of much higher risk. This may be part of the reason that the most frequent lawsuit against Emergency Physicians is for missed orthopedic injury. We reviewed the use of MRI and CT for occult hip fractures (OHF) detection at a major urban trauma unit. Our study is a retrospective review. Inclusion criteria: all patients presenting to the Emergency Clinical Hospital of Constanta with a suspected, posttraumatic, occult hip fracture, over a 5 years period were included. All patients had negative initial radiographs and underwent further imaging with either CT or MRI. A total of 185 cases meeting the inclusion criteria were identified. 72 occult hip fractures were detected with both imaging modalities. Although MRI certainly enables greater image detail, in our experience both modalities are able to provide satisfactory fracture characterization. The choice of imaging should be determined by availability and indication. MRI provides superior imaging of soft tissue but is less sensitive for degenerative changes in presence of bone edema.

scholarly journals The Value of CT Three-Dimensional Reconstruction in Nursing and Diagnosis of Senile Hip Fracture

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Yuanyuan Shi ◽  
Si Chen ◽  
Xue Chen ◽  
Pan Xue
Keyword(s):  
Hip Fracture ◽  
3D Reconstruction ◽  
Ct Scan ◽  
Three Dimensional ◽  
The Elderly ◽  
Three Dimensional Reconstruction ◽  
X Ray ◽  
Dimensional Reconstruction ◽  
Bone Fragments ◽  
Conventional Ct

Aim. To study the diagnostic effect of hip fracture in the elderly. In this paper, a total of 100 elderly patients with hip fracture from January 2020 to May 2021 were selected for X-ray and CT examination after admission. The operation was taken as the final criteria for determining hip fracture type, and the diagnosis of hip fracture by CT three-dimensional reconstruction was analyzed and studied. The results showed that the diagnostic rate of CT 3D reconstruction for various types of hip fracture in the elderly was higher than that of CT plain scan and X-ray ( P < 0.05 ). For the diagnosis of intra-articular small bone fragments, the rate of missed diagnosis was 2% (2/100) with CT 3D reconstruction, 10% (10/100) with conventional CT scan, and 20% (20/100) with X-ray. The rate of misdiagnosis was 5.0% (5/100) with CT 3D reconstruction. Routine CT scan was 15% (15/100), X-ray was 30% (30/100), and CT 3D reconstruction was significantly lower than other examinations ( P < 0.05 ). Conclusion. CT 3D reconstruction has high accuracy in the diagnosis of various types of hip fractures in the elderly.

scholarly journals Computed tomography-based diagnosis of occult fragility hip fractures offer shorter waiting times with no inadvertent missed diagnosis

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902093208
Author(s):  
Gin Way Law ◽  
Akshay Padki ◽  
Kae Sian Tay ◽  
Tet Sen Howe ◽  
Joyce Suang Bee Koh ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Waiting Times ◽  
Cross Sectional ◽  
Cancer History ◽  
Surgical Delay ◽  
Occult Hip Fracture ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Purpose: Surgical delay due to the wait for advanced cross-sectional imaging in occult fragility hip fracture management is not well studied. Our study aims to investigate computed tomography (CT) as an alternative to the gold standard magnetic resonance imaging (MRI) in occult hip fracture workup to decrease surgical delay. Methods: We conducted a retrospective review of all CTs and MRIs performed between 2015 and 2017 for patients with clinically suspected fragility hip fractures and negative plain radiographs to investigate surgical delay resulting from the wait for advanced imaging and representations due to missed fractures. Results: A total of 243 scans (42 CTs and 201 MRIs) were performed for occult hip fracture workup over the study timeframe, of which 49 patients (20%) had occult hip fractures [CT: 6 (14%), MRI: 43 (21%), p = 0.296)]. There were no readmissions for fracture in the 12 months following a negative scan. The CT group had shorter waiting times (CT: 29 ± 24 h, MRI: 44 ± 32 h, p = 0.004) without significantly reducing surgical delay (CT: 82 ± 36 h, MRI: 128 ± 58 h, p = 0.196). The MRI group had a higher number of patients with a cancer history ( p = 0.036), reflective of the practice for workup of possible metastases as a secondary intention. Conclusion: Advanced cross-sectional imaging wait times in occult hip fracture workup contribute significantly to surgical delay. Modern CT techniques are not inferior to MRI in detecting occult fractures and may be a suitable alternative in the absence of a cancer history if MRI cannot be obtained in a timely fashion or is contraindicated. Clinicians should utilize the more readily available imaging modality to reduce surgical delay.

scholarly journals Calcaneal BMD Obtained by Dual X-Ray and Laser Predicts Future Hip Fractures—A Prospective Study on 4 398 Swedish Women

2010 ◽  
Vol 2010 ◽  
pp. 1-6 ◽  
Author(s):  
Torkel B. Brismar ◽  
Imre Janszky ◽  
L. I. M. Toft
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Area Under Curve ◽  
Fracture Rate ◽  
X Ray ◽  
T Score ◽  
National Patient Register ◽  
National Patient ◽  
A Prospective Study

The predictive value of dual X-ray and laser (DXL) calcaneal BMD (BMDDXL) on hip fractures was prospectively studied in 4,398 females aged 55 to 99 years. The average follow-up period was 3 years and 11 months with a total of 17,270 person years. Fractures were identified from the national patient register. After inclusion, 130 females sustained a hip fracture. The age adjusted hazard ratio for T-score <−2.5 versus >−2.5 was 2.64. Of all patients who sustained a hip fracture 78% had a T-score of −2.5 or below. The annual hip fracture rate was 0.26% at T-scores ≥−2, but 1.5% at T-scores ≤−2.5. The area under curve for the model including calcanealBMDDXL, follow-up time, and age to prospectively predict hip fractures was 0.84.Conclusions. CalcanealBMDDXLobtained by DXL Calscan predicts hip fractures and may therefore be suitable for diagnosing osteoporosis and for predicting fracture risk.

scholarly journals LO12: The utility of femoral nerve blocks in the emergency department; a national survey of practice

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S31
Author(s):  
J. Ringaert ◽  
J. Broughton ◽  
M. Pauls ◽  
I. Laxdal ◽  
N. Ashmead
Keyword(s):  
Emergency Department ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Femoral Nerve ◽  
Comfort Level ◽  
Emergency Physicians ◽  
First Line ◽  
Nerve Blocks ◽  
Canadian Association ◽  
The University

Introduction: Approximately 30,000 hip fractures occur annually in Canada, and the incidence will increase with an aging population. Pain control remains a challenge with these patients, as many are elderly and prone to delirium. Regional anesthesia has shown to be very effective with minimal risks, but it is not clear how often emergency physicians are using this technique to provide analgesia for patients with proximal hip fractures. This is the first Canada-wide survey to evaluate the use of regional anaesthesia in the emergency department for hip fractures. It also evaluates physician comfort level with performing these blocks, perceived educational needs in this area, and barriers to performing nerve blocks. Methods: A 13-question survey was sent to 1041 members of the Canadian Association of Emergency Physicians via email in January and February of 2016. Data was collected and analysed using an online collection program called “Survey Monkey”. Ethics approval was obtained through the University of Manitoba Research Ethics Board. Results: 272 Emergency physicians and residents took part in the survey. The majority of respondents (75.9%) choose intravenous opioids as their first line of analgesia and only 7.6% use peripheral nerve blocks (PNB) as their first line choice for analgesia in hip fracture. In response to practitioner comfort with PNBs for hip fractures, most were not at all confident (45.0%) in their ability and many respondents have never performed a nerve block for a hip fracture (53.9%). The most commonly identified barriers to performing PNBs include lack of training, the time to perform the procedure and a lack of confidence. A larger percentage of respondents (34.2%), identified having had no training and no knowledge of how to perform PNBs for hip fractures. Conclusion: The vast majority of Canadian emergency physicians who took part in this survey do not utilize PNBs as a method of pain management for hip fractures. Over half have never performed one of these procedures and many have never received training in how to do so. Future efforts should focus on improving access to education, disseminating information regarding the effectiveness of PNB, and addressing logistical barriers in the ED.

scholarly journals Investigation of Occult Hip Fractures: The Use of CT and MRI

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
S. K. Gill ◽  
J. Smith ◽  
R. Fox ◽  
T. J. S. Chesser
Keyword(s):  
Hip Fracture ◽  
Multislice Ct ◽  
Clinical Suspicion ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Femur Fractures ◽  
Occult Hip Fracture ◽  
Magnetic Resonance Imaging Mri ◽  
Current Guidelines ◽  
Ct And Mri

Aim. At present there is no data looking at modern multislice computerised tomography (CT) in the investigation of occult hip fracture. The aim of this study was to retrospectively compare the reports of patients sent for magnetic resonance imaging (MRI) or CT with negative radiographs and a clinical suspicion of a fractured neck of femur.Methods. All patients presenting to the hospital with a clinical suspicion of a hip fracture but initial negative radiographs over a three-year period were included. Patients were either investigated with an MRI scan or CT scan. The presence of a fracture, the requirement for surgery, and any further requirement for imaging were recorded.Results. Over three years 92 patients were included of which 61 were referred for a CT and 31 for an MRI. Thirty-four patients were found to have a fracture. Of these, MRI picked up a fracture in 36% and CT in 38% of referrals.Discussion. Up to 10% of proximal femur fractures may be missed on initial radiographs. Current guidelines state patients should be offered MRI if hip fracture is suspected despite negative hip radiographs. Our findings show that modern multislice CT may be comparable with MRI for detecting occult fracture.

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