From: ClinicalPearl@...
Date: December 3, 2008 5:05:44 AM EST
To: glennskow@...
Subject: EMedHome Clinical Pearl

The New EMedHome Clinical Pearl is: Imaging For The Occult Hip Fracture

Imaging For The Occult Hip Fracture

Plain radiographs are usually sufficient for the diagnosis of hip fracture as they are at least 90% sensitive. However, in the 3–4% of ED patients having hip X-rays who harbor an occult hip fracture, the EP must decide among several methods for further evaluation.

Three major characteristics describe patients with occult hip fractures:  They have a new inability to bear weight, have sustained low-energy trauma such as a fall from a standing height, and tend to be at risk for osteoporosis.  Risk factors for osteoporosis include advanced age, female gender, chronic steroid use, inactivity, and alcoholism.

In a patient who has sustained a low-energy trauma and has risk factors for osteoporosis, the available evidence favors MRI as the diagnostic modality of choice for occult hip fracture (1).  There is scarce evidence in the literature to support the use of CT for occult hip fracture evaluation (1). In addition, resolution of osteoporotic trabecular bone on CT is limited and fracture can lie hidden within.

Bone scanning may be considered as an alternative to MRI.  However, the specificity of scintigraphy is lower (approximately 94%) and pathologies such as arthritis, synovitis, and tumor are known to cause false-positive scans. The largest disadvantage, however, is the usual practice whereby patients are not scanned until at least 72 hours after injury. However, some authors contend that the modern three-phase technique in the first 24 h is indeed accurate (1,2,3).


References:
(1) Cannon J, et al. Imaging choices in occult hip fracture  J Emerg Med. 2008 Oct 27. [Epub ahead of print]
(2) Quinn SF, McCarthy JL. Prospective evaluation of patients with suspected hip fracture and indeterminate radiographs: use of T1-weighted MR images. Radiology. 1993;187:469–471.
(3) Holder LE, et al. Radionuclide bone imaging in the early detection of fractures of the proximal femur (hip): multifactorial analysis. Radiology. 1990;174:509–515.

 

This email was sent from an automated delivery account. Please do not reply to this email as this account is unmonitored. REMOVAL INSTRUCTIONS: To unsubscribe from this feature, visit http://www.emedhome.com, login, and change your email preferences in the Email Services section of My Account.