Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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The Consequence of Delayed Diagnosis of an Occult Hip Fracture

잠행 고관절 골절의 진단 지연의 결과

  • Je, Sangbong (Department of Emergency Medicine, Inje University Sanggye Paik Hospital) ;
  • Kim, Hyejin (Department of Emergency Medicine, Inje University Sanggye Paik Hospital) ;
  • Ryu, Seokyong (Department of Emergency Medicine, Inje University Sanggye Paik Hospital) ;
  • Cho, Sukjin (Department of Emergency Medicine, Inje University Sanggye Paik Hospital) ;
  • Oh, Sungchan (Department of Emergency Medicine, Inje University Sanggye Paik Hospital) ;
  • Kang, Taekyung (Department of Emergency Medicine, Inje University Sanggye Paik Hospital) ;
  • Choi, Seungwoon (Department of Emergency Medicine, Inje University Sanggye Paik Hospital)
  • 제상봉 (인제대학교 의과대학 상계백병원 응급의학과) ;
  • 김혜진 (인제대학교 의과대학 상계백병원 응급의학과) ;
  • 류석용 (인제대학교 의과대학 상계백병원 응급의학과) ;
  • 조석진 (인제대학교 의과대학 상계백병원 응급의학과) ;
  • 오성찬 (인제대학교 의과대학 상계백병원 응급의학과) ;
  • 강태경 (인제대학교 의과대학 상계백병원 응급의학과) ;
  • 최승운 (인제대학교 의과대학 상계백병원 응급의학과)
  • Received : 2015.04.12
  • Accepted : 2015.10.04
  • Published : 2015.09.30
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Abstract

Purpose: Occult hip fracture is not evident on radiographs and the diagnosis is often missed or delayed. This study was undertaken in order to identify the clinical characteristics and complications of patients with a delayed diagnosis of an occult hip fracture. Methods: We retrospectively reviewed patients with occult hip fracture who had normal findings on initial radiographs, the diagnosis was made on additional studies between August 2006 and February 2012. Patients who were diagnosed as having occult hip fractures at the first visit were categorized as non-delayed group and those who were not diagnosed at the first visit were categorized as delayed group. Results: Non-delayed group included 43 patients (86%). In the remaining 7 patients (delayed group), the diagnosis was delayed by a mean of 9.6 days (range 3~19 days). Patients who were diagnosed with an occult fracture on the initial visit presented later than those with a delayed diagnosis (41/43 .vs. 3/7, p=0.002). Other clinical features were no difference between the two groups. Patients in the delayed diagnosis group were more likely to have fracture displacement (4/7 .vs. 0/43)15patients in non-delayed group (34.9%) needed operative treatment, whereas all delayed patients (100%) needed operative treatment. Conclusion: A delayed diagnosis of occult hip fractures was associated with increased rate of displacement and operation. In patients suspected of having occult hip fractures, additional studies should be recommended.

Keywords

References

  1. Thorngren KG. Hip fractures-an enormous public healthproblem. Lakartidningen 2006; 103: 2990-2.
  2. Borgstrom F, Sobocki P, Strom O, Jonsson B. The societalburden of osteoporosis in Sweden. Bone 2007; 40: 1602-9. https://doi.org/10.1016/j.bone.2007.02.027
  3. Kim KC, Ha YC, Kim TY, Choi JA, Koo KH. Initially missed occult fractures of the proximal femur in elderlypatients: implications for need of operation and their morbidity. Arch Orthop Trauma Surg 2010; 130: 915-20. https://doi.org/10.1007/s00402-010-1105-4
  4. Lubovsky O, Liebergall M, Mattan Y, Weil Y, Mosheiff R. Early diagnosis of occult hip fractures MRI versus CT scan. Injury 2005; 36: 788-92. https://doi.org/10.1016/j.injury.2005.01.024
  5. Helland EB, Tollefsen I, Reksten G. Radiographic diagnosis of the occult hip fracture: experience in 16 patients. Acta Orthop Scand 2000; 71: 639-41. https://doi.org/10.1080/000164700317362316
  6. Verbeeten KM, Hermann KL, Hasselqvist M, Lausten GS, Joergensen P, Jensen CM et al. The advantages of MRI in the detection of occult hip fractures. Eur Radiol 2005; 15: 165-9. https://doi.org/10.1007/s00330-004-2421-2
  7. Dominguez S, Liu P, Roberts C, Mandell M, Richman PB. Prevalence of traumatic hip and pelvic fractures in patients with suspected hip fracture and negative initial standard radiographs- a studyof emergency department patients. Acad Emerg Med 2005; 12: 366-9.
  8. Oka M, Monu JU. Prevalence and patterns of occult hipfractures and mimics revealed by MRI. AJR Am J Roentgenol 2004; 182: 283-8. https://doi.org/10.2214/ajr.182.2.1820283
  9. Perron AD, Miller MD, Brady WJ. Orthopedic pitfalls in theED: radiographically occult hip fracture. Am J Emerg Med 2002; 20: 234-7. https://doi.org/10.1053/ajem.2002.33007
  10. Nachtrab O, Cassar-Pullicino VN, Lalam R, Tins B, Tyrrell PN, Singh J. Role of MRI in hip fractures, including stress fractures, occult fractures, avulsion fractures. Eur J Radiol 2012; 81: 3813-23. https://doi.org/10.1016/j.ejrad.2011.04.003
  11. Moore MN. Orthopedic pitfalls in emergency medicine. South Med J 1988; 81: 371-8. https://doi.org/10.1097/00007611-198803000-00019
  12. Bentley G. Treatment of nondisplaced fractures of thefemoral neck. Clin Orthop Relat Res 1980; 152: 93-101.
  13. Tidermark J, Zethraeus N, Svensson O, Tornkvist H, Ponzer S. Quality of life related to fracture displacement amongelderly patients with femoral neck fractures treated with internal fixation. 2002. J Orthop Trauma 2003; 17: S17-21. https://doi.org/10.1097/00005131-200309001-00005
  14. Blickenstaff LD, Morris JM. Fatigue fracture of the femoral neck. J Bone Joint Surg Am 1966; 48: 1031-47. https://doi.org/10.2106/00004623-196648060-00001
  15. Nodzo SR, Hohman DW, Galpin RD. Bilateral acetabular fractures in an adolescent after low-energy trauma. Pediatr Emerg Care 2012; 28: 568-9. https://doi.org/10.1097/PEC.0b013e318258bfd3
  16. Frihagen F, Nordsletten L, Tariq R, Madesn JE. MRI diagnosis ofoccult hip fractures. Acta Orthop 2005; 76: 524-30. https://doi.org/10.1080/17453670510041510
  17. Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, FrankelVH. Postoperative complications and mortality associatedwith operative delay in older patients whohave a fracture of the hip. J Bone Joint Surg Am 1995; 77: 1551-6. https://doi.org/10.2106/00004623-199510000-00010
  18. Sankey RA, Turner J, Lee J, Healy J, Gibbons CE. The useof MRI to detect occult fractures of the proximal femur: a studyof 102 consecutive cases over a ten-year period. J Bone Joint Surg Br 2009; 91: 1064-8.
  19. GillSK, Smith J. Fox R,Chesser TJ. Investigation of Occult Hip Fractures: The Use of CT and MRI. Scientific World Journal 2013; 2013: 830319.
  20. Memarsadeghi M, Breitenseher MJ, Schaefer-Prokop C, Weber M, Aldrian S, Gabler C et al. Occult scaphoid fractures: comparison ofmultidetector CT and MR imaging-initial experience. Radiology 2006; 240: 169-76. https://doi.org/10.1148/radiol.2401050412
  21. Collin D, Dunker D, Gothlin JH, Geijer M. Observer variation for radiography, computed tomography, and magnetic resonance imaging of occult hip fractures. Acta Radiol 2011; 52: 871-4. https://doi.org/10.1258/ar.2011.110032
  22. Cabarrus MC, AmbekarA, Lu Y, Link TM. MRI andCT of insufficiency fractures of the pelvis and the proximalFemur. AJR Am J Roentgenol 2008; 191: 995-1001. https://doi.org/10.2214/AJR.07.3714
  23. Hayes CW, Balkissoon AR. Current concepts in imagingof the pelvis and hip. Orthop Clin North Am 1997; 28: 617-42. https://doi.org/10.1016/S0030-5898(05)70310-2