Abstract
BackgroundAcute hip pain caused by femoral proximal fractures or acute hip arthritis requires imaging for accurate diagnosis. Although pocket-sized ultrasound (PsUS) offers several advantages over other imaging modalities, there is limited information regarding its use in diagnosing femoral proximal fractures or acute hip arthritis. Thus, we aimed to validate the diagnostic accuracy of PsUS for both disorders.MethodsIn this prospective observational study, outpatients with acute hip pain were diagnosed according to a fixed procedure of the PsUS probe handling. We verified the diagnostic accuracy of PsUS findings (cortical discontinuity and joint fluid retention) and compared it with that of radiography, computed tomography, and magnetic resonance imaging.ResultsOur study included 52 outpatients (mean age, 78.0 years; female, 88.5%). Of 26 patients diagnosed with femoral proximal fractures, 14 had femoral neck fractures and 12 had femoral trochanteric fractures. The sensitivity and specificity for identifying cortical discontinuity in femoral proximal fractures were 0.96 and 0.92, respectively. The sensitivity for identifying either cortical discontinuity or joint fluid retention in femoral proximal fractures or acute hip arthritis was 0.97.ConclusionsNegative PsUS findings of cortical discontinuity and joint fluid retention in the hip are useful for ruling out femoral proximal fractures and acute hip arthritis. PsUS and radiography have comparable diagnostic accuracies, and PsUS could aid in the initial assessment of acute hip pain among the elderly in primary care settings.
Highlights
Acute hip pain caused by femoral proximal fractures or acute hip arthritis requires imaging for accurate diagnosis
The current study shows that pocket-sized ultrasound (PsUS) is used by physicians in the primary care setting
We evaluated the diagnostic accuracy (Sn and Sp) of cortical discontinuity and joint fluid retention assessed using PsUS by comparing it with radiography, computed tomography (CT), and magnetic resonance imaging (MRI)
Summary
Acute hip pain caused by femoral proximal fractures or acute hip arthritis requires imaging for accurate diagnosis. Pocket-sized ultrasound (PsUS) offers several advantages over other imaging modalities, there is limited information regarding its use in diagnosing femoral proximal fractures or acute hip arthritis. There are various causes of acute anterior hip pain, including femoral proximal fractures and acute hip arthritis. Femoral proximal fracture often requires surgery and is generally diagnosed using radiography and, occasionally, computed tomography (CT), which reveal an intraarticular hematoma with cortical discontinuity. Except infectious arthritis, does not require surgery and is often revealed on radiography and magnetic resonance imaging (MRI) as joint fluid retention. US devices have become more affordable, smaller, and more portable They have often been called next-generation stethoscopes [5, 6]. One case report was reported using US for femoral proximal fracture [9]
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