Occult fractures of the proximal femur: imaging diagnosis and management of 82 cases in a regional trauma center
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WORLD JOURNAL OF EMERGENCY SURGERY
RESEARCH ARTICLE
Open Access
Occult fractures of the proximal femur: imaging diagnosis and management of 82 cases in a regional trauma center Bogdan Deleanu1,2, Radu Prejbeanu1,2, Eleftherios Tsiridis6, Dinu Vermesan1,2, Dan Crisan1* , Horia Haragus1, Vlad Predescu4,5 and Florin Birsasteanu2,3
Abstract 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. Keywords: Occult, Hip, Fracture, X-ray, MRI, CT scan
Background The estimated prevalence of occult hip fractures varies between 2 and 10 % of the total hip fractures [1–7]. Occult are defined, those fractures that cannot be detected by radiographic standard examination until several weeks after injury [8]. Their importance resides in their “occult” status, meaning that they are not identifiable by routine emergency X-rays. In the Emergency Room (ER) most of the times only a pelvic or hip AP view is obtained, with some services requiring a complete trauma X-Ray set * Correspondence: [email protected] 1 I-st Clinic of Orthopedics and Trauma, Pius Brinzeu Emergency Clinical County Hospital, 10 I. Bulbuca Blvd, 300737 Timisoara, Romania Full list of author information is available at the end of the article
with lateral, inlet, outlet and Judet oblique views. The necessity of these explorations is however disputed as the presence of a concomitant pelvic fracture either radio
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