The Consequence of Delayed Diagnosis of an Occult Hip Fracture

Je, Sangbong; Kim, Hye-Jin; Ryu, Seokyong; Cho, Sukjin; Oh, Sungchan; Kang, Taekyung; Choi, Seungwoon

doi:10.20408/jti.2015.28.3.91

Cited by 5 publications

(1 citation statement)

References 22 publications

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“…Previously, mobile patients who are unable to ambulate following trauma are a diagnostic challenge. The complications of overinvestigation must be balanced against the high morbidity of missing a hip fracture [ 5 ]. CT imaging is typically reserved for patients with a clinical suspicion of a hip fracture despite initial negative or inconclusive imaging.…”

Section: Discussionmentioning

confidence: 99%

The Necessity of CT Hip Scans in the Investigation of Occult Hip Fractures and Their Effect on Patient Management

Gatt

Cutajar

Borg

et al. 2021

Advances in Orthopedics

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The diagnostic challenge of negative plain radiography in the context of a previously ambulatory patient is increasing with the rise in geriatric trauma. These patients are often diagnosed with small undisplaced fractures of the pelvis and femur which may not alter management. This study aims to assess the frequency at which computed tomography (CT) hip scans altered patient management and whether two X-ray projections of the hip affected fracture detection rate. All CT hip scans performed over a three-year period were identified retrospectively. Only CT hips pertaining to the identification of occult fractures were included in the study. A total of 447 (63.6%) CT hips were performed to exclude an occult fracture, which was only detected in 108 (24.1%) of the scans requested. The majority were subcapital (n = 58, 53.7%) or intertrochanteric (n = 39, 36.1%). There was no significant difference between fracture detection rates when comparing one and two views of the pelvis. 82.4% (n = 89) of occult hip fractures were managed operatively. CT imaging led to a change in patient management in 20% of cases. The frequency at which CT scan detects and alters management in occult hip fractures confirms the justification for its use. Increasing the number of X-ray projection views does not decrease the reliance on CT. Pelvic ring fractures are common in nonambulatory patients following trauma, and if confirmed on initial imaging, subsequent imaging to exclude a concurrent occult hip is unnecessary. The focus of further research should be towards the development of investigation algorithms which decrease the reliance on CT and defining the optimal surgical criteria for occult hip fractures.

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Section: Discussionmentioning

confidence: 99%

The Necessity of CT Hip Scans in the Investigation of Occult Hip Fractures and Their Effect on Patient Management

Gatt

Cutajar

Borg

et al. 2021

Advances in Orthopedics

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Clinical characteristics and short to mid term functional outcomes of surgically treated occult hip fractures in the elderly

Thwin

Kwek

2018

Injury

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Influence of Risk Factors for Hip Injuries and Effect of Co-Morbidities on Postoperative Complications and Outcome after Hip Fracture Surgery in the Elderly

Reddy¹,

Hussain²,

Raju³

et al. 2023

Journal of Orthopaedic Diseases and Traumatology

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Background: Older adults who sustain hip fractures usually have multiple comorbidities that may impact their treatment and outcome. This study aims to analyze the risk factors that contribute to falls in elders and analyze the effect of comorbidities on the outcome and the treatment decision-making in elderly patients with hip fractures. Materials and Methods: This cohort study was conducted on patients with hip fractures. We prospectively analyzed 140 cases of geriatric hip fractures who had undergone surgery. The Charlson Comorbidity Index (CCI) and American Society of Anesthesiologists (ASA) of each geriatric hip fracture patient were calculated based on data retrieved from the medical records. Clinical assessment was assessed using a modified Harris hip score during each visit. Results: The mean age of patients was 72.21 ± 12.2 years. The mean CCI was 1.02 ± 0.3, and ASA was 2.0 ± 0.53, and both were significantly associated with time-to-surgery (P < 0.001) and surgical treatment (P < 0.001). The length of hospital stay, duration of postoperative intensive care, and hospital expenses were associated with both CCI (P = 0.037) and ASA (P = 0.002). Greater the CCI and ASA, more chances of developing postoperative complications (χ2 = 15.724, P = 0.001). Delirium is the most common postoperative complication 15.7%, and pulmonary infection 11.4% is the most lethal complication. Conclusions: Patients with high CCI, ASA grading, and revision surgery are at high risk of developing postoperative complications, morbidity, and mortality. With efficient medical co-management of these patients, orthogeriatric care offers the best chance for a successful outcome.

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The Consequence of Delayed Diagnosis of an Occult Hip Fracture

Cited by 5 publications

References 22 publications

The Necessity of CT Hip Scans in the Investigation of Occult Hip Fractures and Their Effect on Patient Management

The Necessity of CT Hip Scans in the Investigation of Occult Hip Fractures and Their Effect on Patient Management

Clinical characteristics and short to mid term functional outcomes of surgically treated occult hip fractures in the elderly

Influence of Risk Factors for Hip Injuries and Effect of Co-Morbidities on Postoperative Complications and Outcome after Hip Fracture Surgery in the Elderly

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