High clinical utility of computed tomography compared to radiography in elderly patients with occult hip fracture after low-energy trauma |
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Authors: | Dennis Dunker David Collin Jan H G?thlin Mats Geijer |
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Institution: | (1) Department of Radiology, Sahlgrenska University Hospital, M?lndal, Sweden;(2) Center for Medical Imaging and Physiology, Sk?ne University Hospital, 221 85 Lund, Sweden;(3) Lund University, Lund, Sweden; |
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Abstract: | To evaluate the clinical utility of computed tomography (CT) compared to radiography in evaluating suspect or missed hip fractures
in elderly after low-energy trauma. One hundred ninety-three hip CT examinations performed in two trauma centers during 3 years
of evaluation of clinically suspect or occult hip fracture within 24 h of negative or suspect radiography were retrospectively
reviewed. Consensus CT diagnosis by three observers was compared to clinical outcome and in some cases also further imaging.
All patients were elderly and had sustained a low-energy trauma. Eighty-four examinations revealed no fracture. Follow-up
was uneventful but for two patients who had been operated. Thirty-nine of 41 cervical hip fractures were surgically or otherwise
confirmed, two cases were not operated due to week-old trauma and moderate symptoms. Twenty-nine of 68 trochanteric fractures
or avulsions were confirmed surgically. Computed tomography has a high clinical utility as it can detect nearly all clinically
suspect but radiographically negative cervical hip fractures as well as most trochanteric fractures and avulsions. A negative
CT is near-perfect in ruling out a hip fracture requiring surgery. |
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