Electronic databases of MEDLINE, EMBASE, CINAHL, and the Cochrane Library as well as the Google Scholar search engine were used. Studies written in the English language highlighting the use of magnetic resonance imaging (MRI) and computed tomography in diagnosing occult proximal femoral fractures despite negative or equivocal plain radiographs were included. Two reviewers independently extracted data from each article. Raw frequencies for each of the details investigated were calculated. 15 prospective and 7 retrospective studies from 1989 to 2009 were included in this systematic review. A total of 996 patients (mean age, 75 years; standard deviation, 5 years) with suspected occult proximal femur fractures underwent MRI for further assessment. 350 (35%) of the patients tested positive for proximal femoral fractures, of whom 295 (84%) underwent further treatment/surgical interventions. MRI also detected other fractures and soft-tissue injuries. MRI was superior to other imaging modalities in diagnosing occult proximal femoral fractures and should be performed within 24 hours of injury. Early diagnosis and management may avoid substantial displacement and complications, and improve overall mortality and morbidity.
A suspected case of acute coronary syndrome presented with new-onset left bundle branch and first-degree heart blocks. The decision to thrombolyse was reverted as ECG changes proved to be transient within fifteen minutes of presentation. Later on the patient was diagnosed with acute pancreatitis based on laboratory results of serum amylase, confirmed on radiological investigations.
A 75-year- old man was referred to hospital with a 24 hour history of severe neck pain, associated with fever, rigors and mild confusion. The pain radiated into his arms and was exacerbated by neck movements. Eight days prior to admission he had developed loose stools for 3 days. There was no history of trauma, and no other features of meningism. He gave a past history of ischemic heart disease and atrial fibrillation for which he was taking warfarin. Examination revealed a pyrexia of 38.3c. There was tenderness over the cervical spine but no other positive findings. Neurological examination was unremarkable.
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