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

2.50
Hdl Handle:
http://hdl.handle.net/11287/593854
Title:
The use of computed tomography in identifying radiologically occult hip fractures in the elderly
Authors:
Heikal, S.; Riou, Peter; Jones, Lewis
Abstract:
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.
Citation:
Ann R Coll Surg Engl. 2014 Apr;96(3):234-7.
Publisher:
Royal College of Surgeons
Journal:
Annals of the Royal College of Surgeons of England
Issue Date:
1-Apr-2014
URI:
http://hdl.handle.net/11287/593854
DOI:
10.1308/003588414X13824511650533
PubMed ID:
24780791
Additional Links:
http://publishing.rcseng.ac.uk/doi/abs/10.1308/003588414X13824511650533?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
Type:
Journal Article
Language:
eng
ISSN:
1478-7083
Appears in Collections:
Emergency Department; 2014 RD&E publications

Full metadata record

DC FieldValue Language
dc.contributor.authorHeikal, S.en
dc.contributor.authorRiou, Peteren
dc.contributor.authorJones, Lewisen
dc.date.accessioned2016-01-19T12:35:47Zen
dc.date.available2016-01-19T12:35:47Zen
dc.date.issued2014-04-01en
dc.identifier.citationAnn R Coll Surg Engl. 2014 Apr;96(3):234-7.en
dc.identifier.issn1478-7083en
dc.identifier.pmid24780791en
dc.identifier.doi10.1308/003588414X13824511650533en
dc.identifier.urihttp://hdl.handle.net/11287/593854en
dc.description.abstractINTRODUCTION: 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.en
dc.language.isoengen
dc.publisherRoyal College of Surgeonsen
dc.relation.urlhttp://publishing.rcseng.ac.uk/doi/abs/10.1308/003588414X13824511650533?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmeden
dc.titleThe use of computed tomography in identifying radiologically occult hip fractures in the elderlyen
dc.typeJournal Articleen
dc.identifier.journalAnnals of the Royal College of Surgeons of Englanden

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