scholarly journals The use of computed tomography in identifying radiologically occult hip fractures in the elderly

2014 ◽  
Vol 96 (3) ◽  
pp. 234-237 ◽  
Author(s):  
S Heikal ◽  
P Riou ◽  
L Jones
Keyword(s):  
Computed Tomography ◽  
Hip Fractures ◽  
Historical Review ◽  
The Elderly ◽  
Acetabular Fractures ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
X Ray ◽  
Magnetic Resonance Imaging Mri ◽  
Occult Hip Fractures

Introduction Fractured neck of femur (NOF) is a cause of significant morbidity and mortality. Approximately 4% of patients with an initial normal hip x-ray in the emergency department (ED) will in fact have an occult fracture. In cases where there is ongoing clinical suspicion of NOF fracture despite a normal hip x-ray, alternative imaging should be used. Although available evidence supports the use of magnetic resonance imaging (MRI) for this, it is often not readily accessible from the ED. In our department, it is common practice to request computed tomography (CT). Methods A historical review was undertaken of all patients who presented between October 2007 and January 2011 who had CT requested by ED staff. Patients included in the study were those who presented following low impact trauma in whom fractured NOF was suspected despite a normal x-ray. Results Of the 65 included patients, fractures (pelvic and hip) were identified in 38 patients on CT. Fractured NOFs were found in 13 patients. Acetabular fractures were found in nine patients, five of whom required further orthopaedic management. One patient went on to have MRI to confirm the diagnosis of an impacted NOF fracture, suspected both on x-ray and CT. Further review was undertaken of the medical notes of discharged patients to identify any who reattended or required further imaging. No such cases were found. Conclusions This review has shown the use of CT to be a practical approach to improving the care of patients with occult hip fractures.

scholarly journals Management of Warfarin Anticoagulation in Patients with Fractured Neck of Femur

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Feras Ashouri ◽  
Wissam Al-Jundi ◽  
Akash Patel ◽  
Jitendra Mangwani
Keyword(s):  
Vitamin K ◽  
Hip Fractures ◽  
National Policy ◽  
District General Hospital ◽  
Pharmacological Therapy ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Time To Surgery ◽  
Group A ◽  
Group B

Background. Most orthopaedic units do not have a policy for reversal of anticoagulation in patients with hip fractures. The aim of this study was to examine the current practice in a district general hospital and determine difference in the time to surgery, if any, with cessation of warfarin versus cessation and treatment with vitamin K. Methods. A retrospective review of the case notes between January 2005 and December 2008 identified 1797 patients with fracture neck of femur. Fifty seven (3.2%) patients were on warfarin at the time of admission. Patients were divided into 2 groups (A and B). Group A patients (16/57; 28%) were treated with cessation of warfarin only and group B patients (41; 72%) received pharmacological therapy in addition to stopping warfarin. Time to surgery between the two groups was compared. Results. The mean INR on admission was 2.9 (range 1.7–6.5) and prior to surgery 1.4 (range 1.0–2.1). Thirty eight patients received vitamin K only and 3 patients received fresh frozen plasma and vitamin K. The average time to surgery was 4.4 days in group A and 2.4 days in group B. The difference was statistically significant (P<.01). Conclusion. Reversal of high INR is important to avoid significant delay in surgery. There is a need for a national policy for reversing warfarin anticoagulation in patients with hip fractures requiring surgery. Vitamin K is safe and effective for anticoagulation reversal in hip fracture patients.

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 Preoperative and Postoperative Oxygen Saturation in the Elderly following Spinal or General Anaesthesia—An Audit of Current Practice

1994 ◽  
Vol 22 (2) ◽  
pp. 150-154 ◽  
Author(s):  
A. G. Brown ◽  
A. R. Visram ◽  
R. D. M. Jones ◽  
M. G. Irwin ◽  
J. Bacon-Shone
Keyword(s):  
Elderly Patients ◽  
Oxygen Saturation ◽  
Signal Amplitude ◽  
The Elderly ◽  
Analysis Data ◽  
General Anaesthetic ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Screw Insertion ◽  
Hip Screw

We have compared the incidence of preoperative and postoperative oxygen desaturation in 20 elderly patients undergoing dynamic hip screw insertion for fractured neck of femur, allocated randomly to two groups to receive subarachnoid anaesthesia (SA, n = 10) or a general anaesthetic (GA, n = 10). Oximetry data were recorded during the preoperative night and the first 48 hours after surgery using Satmaster.™ Data associated with zero amplitude signal were automatically invalidated by the software and decreases in SpO2 which were preceded by contemporaneous changes in signal amplitude which conformed to a previously described template were assumed to be artefactual and were discarded from final data analysis. Data demonstrated a wide interpatient variability. However, those patients who desaturated preoperatively continued to do so in the postoperative period. The differences between the preoperative and postoperative oximetry profiles were examined for each patient and demonstrated a significantly longer time spent with SpO2 <90% in the GA group compared with the SA group, in all the recorded time periods, except on the day of surgery. The SA group showed an improvement in oxygen saturation postoperatively when compared to the preoperative night, spending less time with an SpO2 <85%. We conclude that the subarachnoid anaesthetic technique was associated with a lower incidence of postoperative oximetry desaturation when compared with general anaesthetic for these elderly patients undergoing repair of fractured neck of femur.

scholarly journals Another fractured neck of femur: do we need a lateral X-ray?

2011 ◽  
Vol 84 (1001) ◽  
pp. 413-417 ◽  
Author(s):  
B Almazedi ◽  
C D Smith ◽  
D Morgan ◽  
G Thomas ◽  
G Pereira
Keyword(s):  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
X Ray

scholarly journals Use of Computed Tomography Compression Ratio in Diagnosis of Disc Injuries and Posterior Ligamentous Complex Injuries in Osteoporotic Thoracolumbar Compression Fractures

2021 ◽  
Vol 18 (4) ◽  
Author(s):  
Dong Liu ◽  
Dan Zhong ◽  
Aihong Cao
Keyword(s):  
Computed Tomography ◽  
Compression Ratio ◽  
Body Height ◽  
The Elderly ◽  
Diagnostic Value ◽  
Ct Scans ◽  
Posterior Ligamentous Complex ◽  
Compression Fractures ◽  
Study Population ◽  
Magnetic Resonance Imaging Mri

Background: Osteoporotic compression fractures are common among the elderly. It is important to predict the posterior ligamentous complex (PLC) and disc injuries in computed tomography (CT) scans of patients with magnetic resonance imaging (MRI) contraindications. Objectives: To determine the role of the CT compression ratio (CTCR) in diagnosing PLC and disc injuries and to compare it with the loss of vertebral body height (LOVBH) in osteoporotic thoracolumbar compression fractures. Patients and Methods: A total of 91 consecutive patients with vertebral fractures were included as the study population. The PLC and disc injuries were assessed using MRI, and the following radiological parameters were determined based on CT scans for further MRI examinations: CTCR, LOVBH, local kyphosis (LK), interspinous widening (ISW), vertebral translation (VBT), and posterior structures fractures (PSF). Statistical analysis was performed to identify the diagnostic value of CT features in PLC and disc injuries. Results: The PLC injuries were detected in 9/91 cases, and the number of disc injuries was 47/91. Neither CTCR nor LOVBH was associated with PLC injuries (P > 0.05). However, the CTCR was associated with disc injuries (P < 0.05), with an optimal threshold of 1.755 (sensitivity, 68.1%; specificity, 79.5%), while the LOVBH was not significantly associated with disc injuries. Based on the results, VBT was significantly related to PLC and disc injuries (P < 0.05). Conclusion: The injured vertebral CTCR was associated with disc injuries rather than PLC injuries, suggesting that compression fractures are relatively stable with less PLC injury. Overall, CTCR is a useful indicator reflecting the compression degree of the injured vertebrae; it is also a valid predictor of disc injuries.

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.

The prediction of visceral fat by dual-energy X-ray absorptiometry in the elderly: a comparison with computed tomography and anthropometry

2002 ◽  
Vol 26 (7) ◽  
pp. 984-993 ◽  
Author(s):  
MB Snijder ◽  
M Visser ◽  
JM Dekker ◽  
JC Seidell ◽  
T Fuerst ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Visceral Fat ◽  
The Elderly ◽  
Dual Energy ◽  
X Ray

scholarly journals 58 Epidemiology of Falls and HIP Fractures among the Elderly Community Dwellers in Malaysia

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv13-iv17
Author(s):  
Raymond Yeak ◽  
Yee Yee Yap ◽  
Nizlan M Nasir
Keyword(s):  
Nursing Homes ◽  
Hip Fractures ◽  
Asian Population ◽  
The Elderly ◽  
Subtrochanteric Fracture ◽  
Morbidity And Mortality ◽  
Prevention Measures ◽  
Neck Of Femur ◽  
Tertiary Centre ◽  
Type Of Fracture

Abstract Introduction Elderly community dweller has a high risk of falls. It has a high incidence of morbidity and mortality if it involves hip fractures. Our aim is to report the incidence of falls presenting with hip fractures to a Malaysian tertiary centre. Method We have collected data from a Malaysian tertiary centre. The incidence of falls involving elderly patients aged 65 and above from January 2018 till December 2018 was examined. The falls were divided based on the time of fall, place and the type of fracture. Time of fall was divided into day (0800 to 1559), evening (1600 to 2359), night (0000 to 0759). The place was either outdoor or indoor. Results There were 114 falls that involved hip fractures recorded over the past 12 months. There were 85 female cases versus 29 male cases. The average age was 77.3 years. There was a higher incidence in the Chinese (n=59) followed by the Malay (n=40) and Indian (n=15). There were no cases of nursing homes falls that involved hip fractures. Most of the falls with hip fractures occurred indoor with only 11 cases that occurred outdoor. The falls tend to occur in the day (n=65) followed by evening (n=31) and night (n=18). October recorded the highest number of falls with 14 cases followed by April (n=13), and December (n=12). The type of fracture in descending order were intertrochanteric fracture (n=61), neck of femur fracture (n=47), subtrochanteric fracture (n=4) and acetabular fracture (n=2). Conclusion Asians generally care for their aging parents in the family home. Although falls were reported to be higher in nursing homes, this differs in the Asian population. Therefore, fall prevention measures should be implemented at home as falls is a significant cause of morbidity and mortality in the elderly especially if it involves hip fractures.

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