Prevalence of Traumatic Hip and Pelvic Fractures in Patients with Suspected Hip Fracture and Negative Initial Standard Radiographs—A Study of Emergency Department Patients

Abstract

Objectives: To determine the prevalence of hip and pelvic fractures in emergency department (ED) patients with hip pain and negative standard initial radiographs. Methods: This was a retrospective, cohort study at an academic, community-based ED. ED patients presenting during a oneyear period with hip pain for whom a plain-film radiograph was obtained were included. Eligible patients were identified by query of electronic records. Plain radiographs and magnetic resonance images (MRIs) were ordered at the discretion of the treating physician. Initial plain radiographs were read at the point of care by board-certified radiologists. MRI images were reviewed by radiologists with fellowship training in musculoskeletal imaging. Structured follow-up at more than one month postvisit was conducted to rule out a subsequent diagnosis of hip fracture. Ninety-five-percent confidence intervals (95% CIs) and kappa (k) were calculated as appropriate. Results: Seven hundred sixty-four of 895 patients (85.3%) had follow-up completed (study group). Within the study group, 219 patients (29%) had

High clinical utility of computed tomography compared to radiography in elderly patients with occult hip fracture after low-energy trauma

“…There were 21% cervical hip fractures, and 35% trochanteric fractures including incomplete fractures and greater trochanteric avulsions. The proportion of findings is similar to that in previous studies using MRI for evaluating occult or missed hip fracture [5,7,21,22]. There was surgical or other confirmation for nearly all detected cervical hip fractures, but only for 29 of 68 (43%) trochanteric fractures, including greater trochanteric avulsions.…”

“…The fracture may, however, simply be impossible to detect with radiography and in 2-9% radiography has been reported to have missed fractures or be suspect for fracture [5][6][7]. Magnetic resonance imaging (MRI) has been reported as a good secondary examination with good interobserver agreement [7,8] but no large material has been presented.…”

Lateral Radiograph of the Hip in Fracture Neck of Femur: Is it a Ritual?

“…Although the reported incidence of occult fracture neck of femurs is about 1.6-4.4% [7,9], incidentally we did not encounter any such case during this period.…”

“…Early diagnosis and appropriate management significantly decreases the morbidity and mortality of the patients [2][3][4][5][6]. Majority of these fractures are relatively easily diagnosed based on clinical findings and plain radiographs, although some studies quote up to 4.4% of them are occult fractures having negative initial radiographs [7]. Traditionally, plain radiographs in clinically suspected hip fractures have included both antero-posterior view (AP) and lateral views (LAT) of the injured hip.…”

Emergency Department Evaluation and Treatment of Acute Hip and Thigh Pain

“…12 Patient vulnerability or a suspicious mechanism should prompt advanced imaging, as up to 11% of patients with suspected fractures and negative radiographs will have delayed diagnosis of an injury. 13,14 A low threshold for the use of computed tomography (CT) or MRI is therefore warranted.…”