Abstract
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.
Highlights
The early diagnosis and treatment of patients sustaining fractures of the proximal femur has led to improved results both in terms of morbidity and mortality
The hospital treated 1353 hip fractures over the three-year period. During this time 92 patients were referred for further imaging for a diagnosis of an occult hip fracture of which 34 (37%) identified a fracture. This gave an occult fracture rate of 2.5%, with 7% of those presenting with a clinical suspicion of a hip fracture requiring further investigation after initial negative radiographs
When the radiographs were retrospectively reviewed by experienced musculoskeletal radiologists or trauma orthopaedic surgeons, 11 of the fractures were evident on the initial films, dropping the actual occult fracture rate to 1.7%
Summary
The early diagnosis and treatment of patients sustaining fractures of the proximal femur (hip fractures) has led to improved results both in terms of morbidity and mortality. Treatment helps with pain control and well as reducing the length of hospital stay. It is recognized 2–10% of fractures may not be clearly visible on initial radiographs, and further imaging is required to make a definitive diagnosis [1,2,3,4,5,6]. These fractures have been termed occult hip fractures. One alternative is multislice computerised tomography (CT) which is more readily available, though there is no evidence of its sensitivity
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