The sensitivity of ct scans in diagnosing occult femoral neck fractures

Sadozai, Zain; Davies, R.; Warner, John J.

doi:10.1016/j.injury.2016.10.019

Cited by 38 publications

(19 citation statements)

References 19 publications

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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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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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“…The opinion that AP-LPR could detect MA-LSTV does not mean that AP-LPR could classify MA-LSTV types accurately. Plain radiography has some inherent limitations-it frequently misses subtle or occult fractures [8] or fails to evaluate bony unions accurately [9]. Recently, some studies have pointed out that coronal MRI is superior to standard AP-LPR in detecting and classifying of MA-LSTV [5,10].…”

Section: Introductionmentioning

confidence: 99%

Lumbar plain radiograph is not reliable to identify lumbosacral transitional vertebra types according to Castellvi classification principle

Hou¹,

Bai²,

Li³

et al. 2020

BMC Musculoskelet Disord

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Background: The anteroposterior view of the lumbar plain radiograph (AP-LPR) was chosen as the original and first radiographic tool to determine and classify lumbosacral transitional vertebra with morphological abnormality (MA-LSTV) according to the Castellvi classification. However, recent studies found that AP-LPR might not be sufficient to detect or classify MA-LSTV correctly. The present study aims to verify the reliability of AP-LPR on detecting and classifying MA-LSTV types, taking coronal reconstructed CT images (CT-CRIs) as the gold criteria. Methods: Patients with suspected MA-LSTVs determined by AP-LPR were initially enrolled. Among them, those who received CT-CRIs were formally enrolled to verify the sensitivity of AP-LPR on detecting and classifying MA-LSTV types according to the Castellvi classification principle. Results: A total of 298 cases were initially enrolled as suspected MA-LSTV, among which 91 cases who received CT-CRIs were enrolled into the final study group. All suspected MA-LSTVs were verified to be real MA-LSTVs by CT-CRIs. However, 35.2% of the suspected MA-LSTV types judged by AP-LPR were not consistent with the final types judged by CT-CRIs. Two suspected type IIIa and 20 suspected type IIIb MA-LSTVs were verified to be true, while 9 of 39 suspected type IIa, 9 and 3 of 17 suspected type IIb, and 11 of 13 suspected type IV MA-LSTVs were verified to truly be type IIIa, IIIb, IV and IIIb MA-LSTVs by CT-CRIs, respectively. Incomplete joint-like structure (JLS) or bony union structure (BUS) and remnants of sclerotic band (RSB) between the transverse process (TP) and sacrum were considered to be the main reasons for misclassification. Conclusion: Although AP-LPR could correctly detect MA-LSTV, it could not give accurate type classification. CT-CRIs could provide detailed information between the TP and sacrum area and could be taken as the gold standard to detect and classify MA-LSTV.

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“…10 MRI has shown a sensitivity approaching 100% and the ability to assess other pelvic injuries. [12][13][14][15] The sensitivity of CT for occult NOF fractures varies in the literature but is estimated to be between 80% and 90%, 4,[16][17][18] with some studies suggesting a sensitivity of 100% when interpreted by musculoskeletal radiologists. 19,20 A systematic review and meta-analysis of 13 studies evaluating CT for occult hip fractures showed a pooled sensitivity of 94% and specificity of 100%.…”

Section: Introductionmentioning

confidence: 99%

Use of computed tomography and magnetic resonance imaging for occult neck of femur fractures: A single‐centre study

Kutaiba

Lamanna

Malara

et al. 2020

Emerg Medicine Australasia

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Objective: Neck of femur (NOF) fractures are common and serious injuries in the elderly. When a NOF fracture is suspected but is not clearly visible on radiographs, guidelines recommend magnetic resonance imaging (MRI), or computed tomography (CT) if MRI is not available/ contraindicated. The aim of our study was to review the use of CT and subsequent MRI for suspected NOF fractures in patients with negative or equivocal radiographs. Methods: A retrospective review of adult patients with negative or equivocal plain radiographs with suspected NOF fractures presenting between 1 July 2015 and 30 June 2017 was performed. Review of CT and subsequent MRI studies was performed with documentation of reported findings, time intervals from plain radiographs to CT and MRI and final outcomes. Results: A total of 184 CT studies in 181 patients were reviewed; median age was 82 years (interquartile range 71-89 years) with 110 (60.8%) female patients. CT reported 20 occult fractures; all proceeded to surgery. MRI was performed in 23 patients and revealed additional four NOF fractures missed by CT. An additional fifth fracture missed by CT was confirmed by followup radiographs. Median time was approximately 4 h from radiographs to CT and approximately 56 h from radiographs to MRI. Conclusion: Access to CT for evaluation of suspected occult NOF fractures is much quicker compared to MRI. When CT results are negative with ongoing clinical suspicion of an occult fracture, MRI should be performed in a time efficient manner.

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The sensitivity of ct scans in diagnosing occult femoral neck fractures

Cited by 38 publications

References 19 publications

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

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

Lumbar plain radiograph is not reliable to identify lumbosacral transitional vertebra types according to Castellvi classification principle

Use of computed tomography and magnetic resonance imaging for occult neck of femur fractures: A single‐centre study

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