Outcomes of Magnetic Resonance Imaging Detected Occult Neck of Femur Fractures: Do They Represent a Less Severe Injury with Improved Outcomes?

Raval, Pradyumna; Mayne, Alistair; Yeap, Phey Ming; Oliver, Thomas; Jariwala, Arpit; Sripada, S.

doi:10.5371/hp.2019.31.1.18

Cited by 3 publications

(2 citation statements)

References 11 publications

(13 reference statements)

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“…4) MRI should be performed even if plain radiographs show some sclerotic changes at the femoral neck, because this can aid in confirming bilateral FNSFs. 11,25) MRI is also useful for diagnosing conditions other than FNSFs, such as osteonecrosis. 3) Concomitant stress fractures were found in 3 patients (25%) in our study, and all lesions involved the proximal tibia.…”

Section: Discussionmentioning

confidence: 99%

Femoral Neck Stress Fractures in South Korean Male Military Recruits

et al. 2021

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Backgroud Femoral neck stress fractures (FNSFs) are rare but potentially disabling injuries if the diagnosis is missed or delayed and proper treatment is not provided. The aim of this study was to investigate and describe the characteristics and clinical course of FNSFs in South Korean male military recruits. Methods Between May 2015 and October 2019, 16 fractures in 12 young male military recruits were reviewed. The characteristics of the fractures were ascertained by detailed analysis of the history and clinical course, as well as radiographs, bone scintigrams, and magnetic resonance images. Results The median duration between endurance training and the development of hip pain was 5 weeks, while the median duration of pain before the patient sought medical attention was 3 weeks. Four patients (33.3%) exhibited bilateral fractures, and concomitant lesions involving the proximal tibia were found in 3 patients (25%). Fourteen of the 16 fractures (87.5%) were compression-type fractures, and surgery was performed for 7 hips. Complete union without malunion or osteonecrosis was achieved in all cases, and all cadets returned to their full activity levels in an average of 10 weeks. Conclusions We observed excellent prognosis of FNSFs. Our report highlights the importance of early reporting, detection, and treatment regarding the challenging management of FNSFs. When a military recruit reports hip pain, a FNSF should be considered; furthermore, the bilaterality of the fracture and the presence of concomitant lesions should also be investigated.

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Section: Discussionmentioning

confidence: 99%

Femoral Neck Stress Fractures in South Korean Male Military Recruits

et al. 2021

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“…This is due to the patient having a concern for an occult femur fracture, and a MRI is the gold standard study for ruling out this diagnosis. 3,[26][27][28][29][30] This patient required an MRI despite undergoing CT imaging. Our study also demonstrated that CT panscans did not improve TTS or decrease LOS in the fragility fracture patient population, which directly contradicts the patterns seen in younger patient populations.…”

Section: Discussionmentioning

confidence: 99%

Is There a Role for CT Pan-Scans in the Initial Workup of Fragility Fracture Patients?

Lepkowsky

Simcox

Rogoff

et al. 2020

Geriatr Orthop Surg Rehabil

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Introduction: Computed tomography (CT) pan-scans have become increasingly commonplace as part of the initial diagnostic workup for patients sustaining traumatic injuries. They have proven effective in improving diagnostic accuracy in those with high-energy mechanisms of injury. However, the utility of pan-scans in the geriatric population sustaining low-energy traumatic injuries remains unproven. Methods: A retrospective review was conducted of patients who sustained a fragility fracture at a level-1 trauma center over a 15-month period. Radiologist interpretations of any CT pan-scans were reviewed for acute findings, and charts were reviewed for resulting changes in orthopedic and nonorthopedic management. Additionally, mechanism of injury, definitive management, time to surgery, length of stay, level of care at discharge, and demographic data were compared against similar patients who did not receive a pan-scan. Results: Of the 109 patients who underwent a CT pan-scan, 1 (0.92%) had a change in orthopedic treatment. Twelve (11.01%) patients had changes to their nonorthopedic management. In addition, 14 other patients had one or more consultations obtained based on pan-scan results that did not result in any change in management. Discussion: This study found that only 1 of the included patients had a change in orthopedic management and 12 had a change in nonorthopedic management, despite over half of the study population being found to have additional findings. Furthermore, patients who underwent a pan-scan did not have expedited surgical intervention or earlier discharges compared to those who were not pan-scanned. Conclusion: This study demonstrates whole-body CT imaging provides little benefit in geriatric patients who sustain fragility fractures and should be utilized judiciously and in a targeted fashion instead of as a routine part of trauma surgery or emergency department protocol in this patient population. Level of Evidence: Level III Retrospective Study.

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Application of Artificial Intelligence to Assist Hip Fracture Diagnosis Using Plain Radiographs

Udombuathong¹,

Srisawasdi²,

Kesornsukhon

et al. 2022

J Southeast Asian Med Res

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Background: Most hip fractures occur among elderly people. They are usually treated in the emergency room where orthopedic surgeons may not be readily available. The problem of delayed diagnosis and treatment results increase risks of further complications and mortality rate. Thus, applying artificial intelligence (AI) can assist physicians having limited experience to rapidly and confidently diagnose hip fractures using radiographs. Objective: This study aimed to validate AI programs to assist diagnosing of hip fractures on plain radiographs. Methods: This study employed a retrospective diagnostic study design. From 1 January 2015 to 31 December 2019, compiled ortho pelvis, anterior-posterior (AP) films from the diagnosis of hip fractures at Ananthamahidol Hospital were performed. The performance of the AI program was compared with one orthopedic surgeon who reviewed the same images. The accuracy, sensitivity and specificity of the diagnosis of hip fractures between the orthopedic surgeon and AI program were analyzed. Results: In total, 217 patients were enrolled in this study. Of these, 56 (28.5%) were male and 161 (74.2%) female. Areas of hip fractures were as follow: intertrochanteric (108, 49.8%), femoral neck (102, 47.0%), subtrochanteric (6, 2.7%) and femoral head (1, 0.5%). The orthopedic surgeon and AI program revealed an accuracy of 93.59% (95%CI 90.8-95.73) vs. 81.24% (95% CI 77.17-84.85), sensitivity of 90.30% (95% CI 85.60-93.90) vs. 89.40% (95%CI 84.50-93.20) and specificity of 97.10% (95%CI 93.60-98.90) vs. 72.5% (95%CI 65.90-78.50), respectively. Conclusion: Our results showed that the AI model (VGG16) showed a sensitivity of 89.40% vs. 90.30% obtained from the orthopedic surgeon. Thus, improvement in the sensitivity and specificity of AI software is further required. In the future, AI models have the potential as useful tools for emergent screening and evaluation of patients with hip fractures using plain radiographs, especially in the Emergency Department where orthopedic surgeons may not be readily available.

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Outcomes of Magnetic Resonance Imaging Detected Occult Neck of Femur Fractures: Do They Represent a Less Severe Injury with Improved Outcomes?

Cited by 3 publications

References 11 publications

Femoral Neck Stress Fractures in South Korean Male Military Recruits

Femoral Neck Stress Fractures in South Korean Male Military Recruits

Is There a Role for CT Pan-Scans in the Initial Workup of Fragility Fracture Patients?

Application of Artificial Intelligence to Assist Hip Fracture Diagnosis Using Plain Radiographs

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