The sensitivity of ct scans in diagnosing occult femoral neck fractures |
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| Affiliation: | 1. Laboratory of Human Anatomy, Thomson Building, School of Life Sciences, College of Medical, Veterinary and Life Sciences, Univeristy of Glasgow, UK;2. Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, UK;1. St. Alphonsus Regional Medical Center, 901 N. Curtis Rd., Ste 501, Boise, ID 83706, United States;2. OrthoIndy Trauma, St. Vincent Trauma Center, Indianapolis, IN, United States;1. Division of Emergency Medicine, Weill Cornell Medical College, New York, NY, United States;2. University of Colorado Medical School, Aurora, CO, United States;3. Division of Geriatric and Palliative Medicine, Weill Cornell Medical College, New York, NY, United States;4. National Center for Injury Prevention and Control, Centers for Disease Control, Atlanta, GA, United States;5. Department of Surgery, Weill Cornell Medical College, New York, NY, United States;1. Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, South Korea;2. Department of Mathematics, College of Natural Science, Ajou University, Gyeonggi, South Korea;1. Department of Surgery, Nassau University Medical Center, East Meadow, NY 11554, USA;2. Division of Trauma, Kings County Hospital Medical Center, Brooklyn, NY 11203, USA;3. Department of Family Medicine, Nassau University Medical Center, East Meadow, NY 11554, USA;4. Department of Epidemiology & Biostatistics, College of Public Health, University of South Florida, Tampa, FL 33612, USA |
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| Abstract: | 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. CT scanning yielded sensitivity was 86% and specificity 98% for occult hip fracture (OHF). The median delay to definitive diagnosis was 37 h. Our results demonstrate that CT scan does not bear sufficient sensitivity to detect all OHFs. We therefore recommend that MRI should be offered when a fracture is suspected. CT scans should be reserved for when MRI is not available, but a negative scan should be confirmed with subsequent MRI. |
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| Keywords: | Radiograph Occult hip fracture Imaging Sensitivity Specificity Computed tomography Trauma |
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