Posttraumatic Painful Hip

Safran, Ori; Goldman, Vladimir; Applbaum, Yaakov; Milgrom, Charles; Bloom, Ronald A.; Peyser, Amos; Kisselgoff, David

doi:10.7863/jum.2009.28.11.1447

Cited by 30 publications

(15 citation statements)

References 22 publications

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“…All trials were prospective observational studies in which participants were subjected to both the intervention and the gold-standard diagnostic modality for the fracture type involved. The control modality was primarily radiography, although CT [12, 18–21] and MRI [22–24] were also employed. In two studies, the authors relied on CT scanning if plain radiography was equivocal [25] or if results were inconsistent between plain x-rays and point-of-care sonography [26].…”

Section: Resultsmentioning

confidence: 99%

“…These varied considerably in sample size, from 15 to 260 subjects, and consisted of participants recruited consecutively upon presentation to the Emergency Department, with the exception of Dallaudière et al, who conducted their research in a prehospital setting [27], and two papers which recruited participants from specialist units, namely hand surgery [12] and rheumatology [22]. The largest bulk of evidence was produced by research conducted in Turkey [13, 19, 26, 28–33] and other Middle-Eastern countries such as Iran [34, 35] and Israel [24], with the remaining 14 studies spread across continental Europe and the Americas.…”

Section: Resultsmentioning

confidence: 99%

“…Other specific injury sites included fractures of the foot and ankle [13, 28, 31, 37, 38], including metatarsal stress fractures [22] and Hill-Sachs injuries [18, 39]. The remaining eight studies focussed on a heterogeneous mixture of upper and lower limb fractures [27, 34] involving the radius and/or ulna [26, 40], humerus and/or femur [25, 41], hip [24] and patella [19].…”

Section: Resultsmentioning

confidence: 99%

“…Despite randomising patient selection in order to minimize researcher influence, this method of sampling may introduce some degree of selection bias if certain characteristics are overrepresented in patients presenting to hospital between specific working hours. Nine studies did not specify whether recruitment of patients was influenced by staffing [18, 24, 26, 27, 29, 34, 35, 39, 40], and four studies recruited all consecutive eligible patients [12, 13, 22, 23].…”

Section: Resultsmentioning

confidence: 99%

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The effectiveness of ultrasound in the detection of fractures in adults with suspected upper or lower limb injury: a systematic review and subgroup meta-analysis

et al. 2019

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BackgroundThe aim of the present review is to assess the effectiveness of ultrasound (US) in the detection of upper and lower limb bone fractures in adults compared to a diagnostic gold standard available in secondary and tertiary care centres (e.g. radiography, CT scan or MRI).MethodsThe review followed PRISMA guidelines and used a database-specific search strategy with Medline, EMBASE and The Cochrane Library plus secondary sources (see supplementary material for completed PRISMA checklist). Diagnostic performance of ultrasound was assessed with a qualitative synthesis and a meta-analysis of two data subgroups.ResultsTwenty-six studies were included (n = 2360; fracture prevalence =5.3 % to 75.0%); data were organised into anatomical subgroups, two of which were subjected to meta-analysis. Sensitivity and specificity ranged from 42.11 − 100% and 65.0 − 100%, with the highest diagnostic accuracy in fractures of the foot and ankle. The pooled sensitivity and specificity of US was 0.93 and 0.92 for upper limb fractures (I2 = 54.7 % ; 66.3%), and 0.83 and 0.93 for lower limb fractures (I2 = 90.1 % ; 83.5%).ConclusionUltrasonography demonstrates good diagnostic accuracy in the detection of upper and lower limb bone fractures in adults, especially in fractures of the foot and ankle. This is supported by pooled analysis of upper and lower limb fracture subgroups. Further research in larger populations is necessary to validate and strengthen the quality of the available evidence prior to recommending US as a first-line imaging modality for prehospital use.Trial registrationThe protocol is registered with the PROSPERO International register of systematic reviews: ID = CRD42017053640.Electronic supplementary materialThe online version of this article (10.1186/s12873-019-0226-5) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The effectiveness of ultrasound in the detection of fractures in adults with suspected upper or lower limb injury: a systematic review and subgroup meta-analysis

et al. 2019

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“…Sonography was found to have 100 % sensibility and 65 % specificity compared to MRI. It could therefore be proposed as a screening tool for occult hip fractures in the absence of readily available MRI [ 29 ]. Auscultatory percussion technique is another useful method to assess patients who present with post-traumatic hip pain and normal radiographs [ 30 ].…”

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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Pathologic Hip Fracture Demonstrated on Ultrasound

Johnson

Winemiller

2019

PM&R

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Posttraumatic Painful Hip

Cited by 30 publications

References 22 publications

The effectiveness of ultrasound in the detection of fractures in adults with suspected upper or lower limb injury: a systematic review and subgroup meta-analysis

The effectiveness of ultrasound in the detection of fractures in adults with suspected upper or lower limb injury: a systematic review and subgroup meta-analysis

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

Pathologic Hip Fracture Demonstrated on Ultrasound

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