Bilateral occult hip fracture

Grad, Willis B.; Desy, Nicholas M.

doi:10.2310/8000.2012.110631

Cited by 4 publications

(3 citation statements)

References 42 publications

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“…Almost all hip fractures presenting to the emergency department are diagnosed by routine plain X-rays. 26 However, an undiagnosed occult ITF fracture can lead to risk of displacement, longer hospital stay, and delayed ambulation. 27,28 Therefore, the necessity of surgical treatment may occur in a GT fracture that seems simple on plain radiography.…”

Section: Discussionmentioning

confidence: 99%

Treatment strategy for elderly patients with the isolated greater trochanteric fracture

et al. 2020

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Background: The objective of this study was to evaluate the risk of femur intertrochanteric fracture associated with femur trochanter major fractures in patients over 65 years of age with magnetic resonance examination for better diagnosis and treatment. Methods: Thirty-one patients who had incomplete femur intertrochanteric fracture diagnosed were included in the study. Patients were classified according to the length of the fracture line crossing the intertrochanteric border. Fracture patterns were described on magnetic resonance imaging coronal views. Group A, pattern 1, greater trochanteric fracture extends to intertrochanteric region with both cortices; Group B, pattern 2, fracture has characteristics of pattern 1 fracture including diametaphysis fracture line; Group C, pattern 3, greater trochanteric fracture only has extending superolateral cortex fracture line of intertrochanteric region; and Group D, pattern 4, fracture has characteristics of pattern 1 fracture and including superior extension to the baso-cervical line. Surgical treatment with dynamic hip screw was applied to all patients with intertrochanteric extension after magnetic resonance examination. Results: This study included 16 women (80.3 ± 6.7 years) and 15 men (76.9 ± 10.94 years). Group A had 11 patients, group B had 8 patients, group C had 6 patients, and group D had 6 patients. Ambulation was initially prescribed for these patients 1 day after the surgery. The average surgery durations of the A, B, C, and D patterns were 44.54 ± 7.56, 49.37 ± 12.65, 49.16 ± 3.76, and 44.16 ± 5.84 min, respectively. No statistically significant differences were observed among the four patterns (P = 0.404). Conclusion: Surgical treatment of the greater trochanteric fracture which is considered an indicator of occult intertrochanteric fracture is a good choice for the treatment because of the procedure safety and early mobilization after the surgery

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Section: Discussionmentioning

confidence: 99%

Treatment strategy for elderly patients with the isolated greater trochanteric fracture

et al. 2020

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“…In the emergency department, most hip fractures are diagnosed based on a routine radiograph [ 2 , 24 ]. However, missing the diagnosis of an occult intertrochanteric fracture may lead to fracture displacement, unnecessary surgery, longer hospitalization time, and delayed rehabilitation [ 2 , 23 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Is magnetic resonance imaging necessary in isolated greater trochanter fracture? A systemic review and pooled analysis

Kim

Ahn

Kim

2015

BMC Musculoskelet Disord

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BackgroundIsolated fractures of the greater trochanter (GT) of the femur are uncommon and few studies have assessed the diagnosis and appropriate therapeutic schedule for these fractures. The current data regarding assessment of isolated fractures of the GT are limited to a few reviews based on the experience of a single institution. Therefore, we asked the following questions: (1) what proportion of cases has an associated extension of the fracture into the intertrochanteric region in isolated GT fracture and (2) what are the treatment options and outcomes of GT fractures with occult intertrochanteric fractures.MethodsWe conducted a systematic review of published studies that evaluated patients who displayed isolated GT fracture on routine radiographic examination and underwent a magnetic resonance imaging (MRI) scan because of the suspicion of extension into the intertrochanteric region. A structured literature review of multiple databases (PubMed, EMBASE, CINAHL, and Cochrane systematic reviews) referenced articles from 1950 to 2015.ResultsA total of 110 patients were identified from 7 published studies. MRI documented isolated GT fractures diagnosed on initial radiographs in only 11 of 110 patients (10 %). In 99 patients (90 %), MRI examinations revealed extension of the fracture into the intertrochanteric region. Surgical fixation was necessary for 61 patients, with a pooled percentage of 55 %. No complications were observed after surgery.ConclusionsOur study has helped to elucidate further the assessment of isolated fracture of the GT. We believe that MRI is a reasonable option for patients presenting with isolated GT fracture on plain radiographs.

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“…Pandey et al conducted an ER based study evaluating patients with traumatic hip pain and negative X-rays by MRI. They identified 22 fractures out of 33 suspected cases, but did not provide a total number of hip fractures for the period [ 21 ]. Dominguez et al found 4.4 % of patients with hip trauma and negative X-rays had a hip or pelvic fracture identified by MRI, representing 9.9 % of the total number of hip fractures [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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BackgroundOccult 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.MethodWe 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.ResultsThe 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 %).ConclusionOccult 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.

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Bilateral occult hip fracture

Cited by 4 publications

References 42 publications

Treatment strategy for elderly patients with the isolated greater trochanteric fracture

Treatment strategy for elderly patients with the isolated greater trochanteric fracture

Is magnetic resonance imaging necessary in isolated greater trochanter fracture? A systemic review and pooled analysis

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

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