Occult fractures of the proximal femur: imaging diagnosis and management of 82 cases in a regional trauma center

World Journal of Emergency Surgery

Florin Birsasteanu¹  Vlad Predescu³  Horia Haragus⁴  Dan Crisan⁴  Dinu Vermesan⁵  Eleftherios Tsiridis²  Radu Prejbeanu⁵  Bogdan Deleanu⁵ 

[1] Department of Radiology, Pius Brinzeu Emergency Clinical County Hospital, 10 I. Bulbuca Blvd, Timisoara, 300737, Romania;Aristotle University Medical School, Thessaloniki, 54124, Greece;Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, Bucharest, 050474, Romania;I-st Clinic of Orthopedics and Trauma, Pius Brinzeu Emergency Clinical County Hospital, 10 I. Bulbuca Blvd, Timisoara, 300737, Romania;Victor Babes University of Medicine and Pharmacy, 2 Eftimie Murgu Square, Timişoara, 300041, Romania

关键词: CT scan;    MRI;    X-ray;    Fracture;    Hip;    Occult;   

Others  :  1233718
DOI  :  10.1186/s13017-015-0049-y

 received in 2015-09-26, accepted in 2015-10-27,  发布年份 2015

【 摘 要 】

Background

Occult hip fractures are often difficult to identify in busy trauma units. We aimed to present our institutions experience in the diagnosis and treatment of occult fractures around the hip and to help define a clinical and radiological management algorithm.

Method

We conducted a seven-year retrospective hospital medical record analysis. The electronic database was searched for ICD-10 CM codes S72.0 and S72.1 used for proximal femoral fractures upon patient discharge. We identified 34 (4.83 %) femoral neck fractures and 48 (4.42 %) trochanteric fractures labeled as occult.

Results

The majority of the cases were diagnosed by primary MRI scan (57.4 %) and 12 were diagnosed by emergency CT scan (14.6 %). For the remaining cases the final diagnosis was confirmed by 72 h CT scan in 9 patients (representing 39 % of the false negative cases) or by MRI in the rest of 14 patients. MRI was best at detecting incomplete pertrochanteric fracture patterns (13.45 % of total) and incomplete fractures of the greater trochanter (3.65 % of total) respectively. It also detected the majority of Garden I femoral neck fractures (20.7 % of total). CT scanning accurately detected 100 % of Garden 2 fractures (2.44 %) and 25 % (3.65 %) of the complete pertrochanteric fractures (false negative 25 %).

Conclusion

Occult fractures should be suspected in all patients with traumatic onset of hip pain that is inconsistent with normal radiographic findings. MRI is the golden standard but not as readily available not as cheap and not quite as quick to perform as as a CT scan. The latter which in turn can provide falsely negative results in the first 24 h. Improved imaging protocols could expedite management and improve treatment.

【 授权许可】

   
2015 Deleanu et al.

【 图 表 】

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