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Occult hip fracture

Z Sadozai, R Davies, J Warner
Non-displaced hip fractures can be difficult to diagnose on plain film radiographs. When there is ongoing clinical suspicion of an occult fracture, further imaging is obtained. We investigated the sensitivity of computed tomography (CT) scans in detecting these fractures and the delays to surgery that three-dimensional imaging causes. We identified 78 CT scans performed for possible hip fractures over the past 3 years with the presence and absence of a fracture recorded. Based on subsequent imaging, the accuracy of CT scans was determined...
October 18, 2016: Injury
Saurabh Vitalkar, Ashmi S Manglunia, Arvind Kulkarni, Ameya D Puranik
Stress insufficiency fracture is usually diagnosed clinically and on the basis of routine X-ray imaging findings. However, the absence of any known predisposing factors and negative or occult radiographic findings pose diagnostic challenges. We report the case of an elderly male patient who presented with a chief complaint of trivial left hip pain and with equivocal radiographic findings. Triphasic (99m)Tc-methylene diphosphonate bone scan and single-photon emission computed tomography/computed tomography helped in arriving at the diagnosis of stress insufficiency fracture involving femoral neck...
July 2016: Indian Journal of Nuclear Medicine: IJNM: the Official Journal of the Society of Nuclear Medicine, India
Brian J Yun, M G Myriam Hunink, Anand M Prabhakar, Marilyn Heng, Shan W Liu, Rameez Qudsi, Ali S Raja
STUDY OBJECTIVE: Hip fractures cause significant morbidity and mortality. Determining the optimal diagnostic strategy for the subset of patients with potential occult hip fracture remains challenging. We determined the most cost-effective strategy for the diagnosis of occult hip fractures from the choices of performing only computed topography (CT), performing only magnetic resonance imaging (MRI), performing CT and if negative performing MRI (MRI selective strategy), or discharging the patient without advanced imaging...
June 10, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Haroon Rehman, Rhys G E Clement, Fergus Perks, Timothy O White
OBJECTIVES: Patients presenting with hip pain but normal plain radiographs may ultimately be shown on further investigation to have suffered an occult hip fracture (OHF). This diagnosis can be made with CT or MRI. Traditionally MRI has been considered a superior modality. We performed a retrospective review of all patients presenting to our service with a suspected OHF over a four-year period, investigated with either CT or MRI. DESIGN: Retrospective review. SETTING: Urban trauma centre...
June 2016: Injury
Till O Klatte, Reza Sabihi, Daniel Guenther, Atul F Kamath, Johannes M Rueger, Thorsten Gehrke, Daniel Kendoff
BACKGROUND: Existing hardware may contribute to increased risk of bacterial contamination and subsequent periprosthetic joint infection (PJI) in conversion shoulder arthroplasty performed for failed fracture fixation. QUESTIONS/PURPOSES: This study examined the incidence of positive pre-operative aspiration and inflammatory marker data, along with correlation of pre-operative positive aspiration or inflammatory markers and subsequent infection following conversion shoulder arthroplasty for failed open reduction and internal fixation (ORIF) and the need for re-operation at 4...
October 2015: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
David Collin, Jan H Göthlin, Martin Nilsson, Mikael Hellström, Mats Geijer
The influence of experience in categorizing suspect and occult fractures on radiography compared to MRI and clinical outcome has not been studied. The aim of this study is to evaluate the importance of experience in diagnosing normal or suspect hip radiographs compared to MRI. Primarily reported normal or suspect radiography in 254 patients with low-energy hip trauma and subsequent MRI was re-evaluated by two experienced reviewers. Primary readings and review were compared. The prevalence of fractures among normal and suspect radiographic studies was assessed...
June 2016: Emergency Radiology
Rhys W Thomas, Huw L M Williams, Eleanor C Carpenter, Kathleen Lyons
OBJECTIVE: 10% of all hip fractures are occult on plain radiography, requiring further investigation to ascertain the diagnosis. MRI is presently the gold standard investigation, but frequently has disadvantages of time delay, resulting in increased hospital stay and mortality. Our aim was to establish whether multidetector CT (MDCT) is an appropriate first-line investigation of occult femoral neck (NOF) fractures. METHODS: From 2013, we elected to use MDCT as the first-line investigation in patients believed to have an NOF fracture with negative plain films...
2016: British Journal of Radiology
Alka Sudhir Karnik, Alpana Karnik, Alpana Joshi
Ultrasound (US) is a simple, non-invasive imaging modality which allows high-resolution imaging of the musculoskeletal (MSK) system. Its increasing popularity in pediatrics is due to the fact that it does not involve radiation, has an ability to visualize non-ossified cartilaginous and vascular structures, allows dynamic imaging and quick contralateral comparison. US is the primary imaging modality in some pediatric MSK conditions like infant hip in developmental dysplasia (DDH), hip joint effusion, epiphyseal trauma and evaluation of the neonatal spine...
June 2016: Indian Journal of Pediatrics
David Collin, Mats Geijer, Jan H Göthlin
BACKGROUND: Computed tomography (CT) for evaluation of occult and suspect hip fractures has been proposed as a good second-line investigation. The diagnostic precision compared to magnetic resonance imaging (MRI) is unclear. PURPOSE: To compare the diagnostic performance of CT and MRI in a retrospective study on patients with suspect and occult hip fractures. MATERIAL AND METHODS: Forty-four elderly consecutive patients with low-energy trauma to the hip were identified where negative or suspect CT was followed by MRI...
January 8, 2016: European Radiology
Sayantan Ray, Partha Pratim Chakraborty, Kaushik Biswas, Anne M Beatrice, Sujoy Ghosh, Satinath Mukhopadhyay, Subhankar Chowdhury
Authors describe a case of oncogenic osteomalacia in a 35-year-old man, who presented with a 2-year history of generalized pain and progressive weakness of lower limbs, eventually became bedbound. At admission, he had severe hip pain resulting from bilateral femoral neck fractures. Laboratory investigations revealed hypophosphatemia, hyperphosphaturia, normocalcemia, elevated alkaline phosphatase and normal serum levels of parathormone and 25-hydroxyvitamin D. Serum fibroblast growth factor 23 (FGF23) level was elevated...
April 2015: Oxford Medical Case Reports
Bogdan Deleanu, Radu Prejbeanu, Eleftherios Tsiridis, Dinu Vermesan, Dan Crisan, Horia Haragus, Vlad Predescu, Florin Birsasteanu
BACKGROUND: Occult hip fractures are often difficult to identify in busy trauma units. We aimed to present our institutions experience in the diagnosis and treatment of occult fractures around the hip and to help define a clinical and radiological management algorithm. METHOD: We conducted a seven-year retrospective hospital medical record analysis. The electronic database was searched for ICD-10 CM codes S72.0 and S72.1 used for proximal femoral fractures upon patient discharge...
2015: World Journal of Emergency Surgery: WJES
Raghu Teja Sadineni, Ashirwad Pasumarthy, Narayan Chander Bellapa, Sandeep Velicheti
BACKGROUND: Few bony injuries and most soft tissue injuries cannot be detected on plain radiography. Magnetic resonance imaging (MRI) can detect such occult bony injuries due to signal changes in bone marrow. In addition to excluding serious bony injuries, it can also identify tendon, ligament, cartilage and other soft tissue injuries and thus help in localizing the cause of morbidity. AIMS AND OBJECTIVES: To determine the MRI imaging patterns in recent bone injuries (less than 4 weeks) following negative or inconclusive plain radiographs...
October 2015: Journal of Clinical and Diagnostic Research: JCDR
Roberto Medero Colon, Mikaela L Chilstrom
BACKGROUND: Hip fractures are common injuries, particularly among elderly patients. Although plain radiographs are the initial imaging modality of choice, approximately 10% of hip fractures are not radiographically evident. Failure to diagnose a hip fracture in the emergency department may result in delayed diagnosis and potentially devastating consequences. CASE REPORT: We report the case of an 81-year-old woman with right hip pain after a fall. Although plain radiographs of the right hip and femur were negative for fracture, point-of-care ultrasound of the right hip demonstrated a cortical disruption in the femur consistent with a fracture...
December 2015: Journal of Emergency Medicine
Ken Shimizu, Hisanori Kameda, Haruo Kawamura, Takeshi Makihara, Yukiyo Shimizu
OBJECTIVE: PATIENTs with secondary hyperparathyroidism caused by chronic kidney disease (CKD) develop secondary osteoporosis, which increases fracture risk. We report a case of insufficiency fractures complicated by secondary osteoporosis caused by chronic renal failure and gastrectomy. PATIENT: A 78-year-old man with a medical history of nephrotic syndrome and gastric cancer experienced an occult intertrochanteric fracture of his left femur after falling. RESULTS: Ten days after the first fracture, the patient was treated with hemodialysis for acute uremic symptoms...
2015: Journal of Rural Medicine: JRM
Sayantan Ray, Partha Pratim Chakraborty, Kaushik Biswas, Sujoy Ghosh, Satinath Mukhopadhyay, Subhankar Chowdhury
This paper shows a case of oncogenic osteomalacia in a 35-year-old man who presented with a 2-year history of generalized pain and progressive weakness of lower limbs, eventually became bed bound. At admission he had severe hip pain resulting from atraumatic femoral neck fractures. Laboratory investigations revealed hypophosphatemia, hyperphosphaturia, normocalcemia, elevated alkaline phosphatase, and normal serum levels of parathormone and 25-hydroxyvitamin D. Serum FGF-23 was elevated. Imaging showed osteoporosis and insufficiency fractures of the femoral neck...
January 2015: Clinical Cases in Mineral and Bone Metabolism
Alexander Antoniadis, Patrick O Zingg, Claudio Dora
INTRODUCTION: Cement extrusions on the femoral side after total hip replacement can occur in approximately 0.3% of cemented primary total hip replacements. Not recognised until a postoperative x-ray is performed, the willingness to dismiss and treat these extrusions conservatively is high. METHODS: We report on 3 patients presenting with sudden onset of thigh pain associated with an inability to weight-bear after a 2 to 15 month period of uneventful healthy recovery from cemented total hip replacement...
November 2015: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
M Haubro, C Stougaard, T Torfing, S Overgaard
OBJECTIVE: To estimate sensitivity and specificity of CT and MRI examinations in patients with fractures of the proximal femur. To determine the interobserver agreement of the modalities among a senior consulting radiologist, a resident in radiology and a resident in orthopaedics surgery. MATERIALS AND METHODS: 67 patients (27 males, 40 females, mean age 80.5) seen in the emergency room with hip pain after fall, inability to stand and a primary X-ray without fracture were evaluated with both CT and MRI...
August 2015: Injury
Yoshimi Endo, Lisa Renner, Tom Schmidt-Braekling, Douglas N Mintz, Friedrich Boettner
Fracture of a ceramic liner of a total hip arthroplasty is rare and is radiographically occult if not displaced. We report on two patients in whom ceramic liner fracture was radiographically occult but was diagnosed on subsequent CT scan through appropriate windowing.
August 2015: Skeletal Radiology
Yongsheng Chen, Amritpal Singh, Yiling Angeline Long, Yu Han Chee
This is the first clinical report of a psoas abscess encountered during a routine hemiarthroplasty surgery for a femoral neck fracture in a man with a recent urinary tract infection. There were no prior symptoms to suggest a psoas abscess, which was present on the same side as the hip fracture, apart from a history of recurrent urinary tract infection. The surgery had to be altered intraoperatively to that of an excision arthroplasty of the displaced non-viable femoral head along with insertion of an antibiotic-impregnated cement spacer into the hip joint...
2014: BMJ Case Reports
E Carlos Rodriguez-Merchan, Luis Moraleda, Primitivo Gomez-Cardero
BACKGROUND: Fractures of the femoral shaft are mostly the result of high-energy accidents that also cause multiple trauma injuries, in particular ipsilateral knee and hip injuries. The purpose of this study was to investigate the incidence of injuries associated with femoral shaft fractures and how many of them were undetected. METHODS: We studied 148 patients (150 femoral shaft fractures) with an average age of 52 (range: 18-97). Femoral shaft fractures were treated with antegrade intramedullary nailing in 118 cases (78...
December 2013: Archives of Bone and Joint Surgery
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