Abstract
The diagnostic challenge of negative plain radiography in the context of a previously ambulatory patient is increasing with the rise in geriatric trauma. These patients are often diagnosed with small undisplaced fractures of the pelvis and femur which may not alter management. This study aims to assess the frequency at which computed tomography (CT) hip scans altered patient management and whether two X-ray projections of the hip affected fracture detection rate. All CT hip scans performed over a three-year period were identified retrospectively. Only CT hips pertaining to the identification of occult fractures were included in the study. A total of 447 (63.6%) CT hips were performed to exclude an occult fracture, which was only detected in 108 (24.1%) of the scans requested. The majority were subcapital (n = 58, 53.7%) or intertrochanteric (n = 39, 36.1%). There was no significant difference between fracture detection rates when comparing one and two views of the pelvis. 82.4% (n = 89) of occult hip fractures were managed operatively. CT imaging led to a change in patient management in 20% of cases. The frequency at which CT scan detects and alters management in occult hip fractures confirms the justification for its use. Increasing the number of X-ray projection views does not decrease the reliance on CT. Pelvic ring fractures are common in nonambulatory patients following trauma, and if confirmed on initial imaging, subsequent imaging to exclude a concurrent occult hip is unnecessary. The focus of further research should be towards the development of investigation algorithms which decrease the reliance on CT and defining the optimal surgical criteria for occult hip fractures.
Highlights
Occult hip fractures are defined as fractures which are not visible on initial two-view conventional radiography of the hip. e incidence is reported to be as high as 10% on initial imaging [1]
With respect to hip pathology in the acute setting, patients are often subjected to a single anteroposterior (AP) view of the pelvis, with some literature claiming that this is sufficient for fracture detection [4]. e diagnostic challenge of negative plain radiography in the context of a previously ambulatory patient is increasing with the rise in geriatric trauma
A total of 702 computed tomography (CT) hip scans were performed over the study period. e majority of these were to exclude occult hip fractures (n 447, 63.6%), with the rest performed for preoperative planning (n 53, 7.5%), postoperative assessment (n 71, 10.1%), and chronic conditions (n 131, 18.7%) (Table 1)
Summary
Occult hip fractures are defined as fractures which are not visible on initial two-view conventional radiography of the hip. e incidence is reported to be as high as 10% on initial imaging [1]. While magnetic resonance imaging (MRI) is the recognised gold standard for diagnosis, this is not always an accessible or cost-effective option in many centres For this reason, there has been a move towards the use of computed tomography (CT) as first-line imaging for occult hip fractures, in view of its high sensitivity and specificity rates [3]. E diagnostic challenge of negative plain radiography in the context of a previously ambulatory patient is increasing with the rise in geriatric trauma. Often these patients are subsequently diagnosed with small undisplaced fractures of the pelvis and femur which might not alter management. Often these patients are subsequently diagnosed with small undisplaced fractures of the pelvis and femur which might not alter management. is raises the question whether or not better initial imaging of the pelvis and hips can detect more subtle pathology, explaining the patient’s symptomatology and decreasing reliance on CT
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call