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

Background Conventional radiography is insufficient for diagnosis in a small but not unimportant number of hip fractures, and secondary imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is warranted. There are no convincing observer variation studies performed for conventional radiography or CT in occult fractures, and no large materials for MRI. Purpose To assess observer variation in radiography, CT and MRI of suspected occult, non-displaced hip fractures, and to evaluate to what extent observer experience or patient age may influence observer performance. Material and Methods A total of 375 patients after hip trauma where radiography was followed by CT or MRI to evaluate a suspected occult hip fracture were collected retrospectively from two imaging centers. After scoring by three observers with varying degrees of radiologic experience, observer variation was assessed by using linear weighted kappa statistics. Results For radiography, agreements between the three observers were moderate to substantial for intracapsular fractures, with kappa values in the ranges of 0.56–0.66. Kappa values were substantial for extracapsular fractures, in the ranges of 0.69–0.72. With increasing professional experience, fewer fractures were classified as equivocal at radiography. For CT and MRI, observer agreements were similar and almost perfect, with kappa values in the ranges of 0.85–0.97 and 0.93–0.97. Conclusion There were almost perfect observer agreements for CT and MRI in diagnosing non-displaced, occult hip fractures. Observer agreements for radiography were moderate to substantial, and observer experience influenced agreement only at radiography.

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“…The diagnostic competence varies between radiologists and hip fractures are overlooked (2). One obvious reason for this is perception errors.…”

Section: Introductionmentioning

confidence: 99%

Observer variation for radiography, computed tomography, and magnetic resonance imaging of occult hip fractures

et al. 2011

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“…The prevalence of occult hip fracture varies widely in the literature with an estimated sensitivity of hip radiography between 91 -98% [3,12]. In a study on 1108 patients, Pathak et al [10] reported a prevalence of 0.7% occult hip fractures, reporting all their false negative cases as invisible on the initial radiographs.…”

Section: Discussionmentioning

confidence: 99%

“…Occult fracture rates of 2 -5% have been reported [3,12,21,22]. The prevalence of occult and suspect hip fractures at our clinic cannot be presented as the radiographies are equally coded for acute and selective examinations and both CT and MRI are used as second-line investigation after hip trauma.…”

Section: Discussionmentioning

confidence: 99%

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Added value of interpreter experience in occult and suspect hip fractures: a retrospective analysis of 254 patients

et al. 2016

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“…[4][5][6] More recent studies suggest that approximately 4% of patients with symptoms suspicious for a hip fracture but with a normal initial hip x-ray in the emergency department (ED) will in fact have an occult hip fracture. 7,8 As a result, where there is high clinical suspicion of hip fracture despite a negative x-ray (patients with signifi cant pain or non-weight bearing after good analgesia), alternative forms of imaging must be considered.…”

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confidence: 99%

The use of computed tomography in identifying radiologically occult hip fractures in the elderly

Heikal

Riou

Jones

2014

annals

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Introduction Fractured neck of femur (NOF) is a cause of significant morbidity and mortality. Approximately 4% of patients with an initial normal hip x-ray in the emergency department (ED) will in fact have an occult fracture. In cases where there is ongoing clinical suspicion of NOF fracture despite a normal hip x-ray, alternative imaging should be used. Although available evidence supports the use of magnetic resonance imaging (MRI) for this, it is often not readily accessible from the ED. In our department, it is common practice to request computed tomography (CT). Methods A historical review was undertaken of all patients who presented between October 2007 and January 2011 who had CT requested by ED staff. Patients included in the study were those who presented following low impact trauma in whom fractured NOF was suspected despite a normal x-ray. Results Of the 65 included patients, fractures (pelvic and hip) were identified in 38 patients on CT. Fractured NOFs were found in 13 patients. Acetabular fractures were found in nine patients, five of whom required further orthopaedic management. One patient went on to have MRI to confirm the diagnosis of an impacted NOF fracture, suspected both on x-ray and CT. Further review was undertaken of the medical notes of discharged patients to identify any who reattended or required further imaging. No such cases were found. Conclusions This review has shown the use of CT to be a practical approach to improving the care of patients with occult hip fractures.

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

Cited by 15 publications

References 9 publications

Observer variation for radiography, computed tomography, and magnetic resonance imaging of occult hip fractures

Observer variation for radiography, computed tomography, and magnetic resonance imaging of occult hip fractures

Added value of interpreter experience in occult and suspect hip fractures: a retrospective analysis of 254 patients

The use of computed tomography in identifying radiologically occult hip fractures in the elderly

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