The Necessity of CT Hip Scans in the Investigation of Occult Hip Fractures and Their Effect on Patient Management

The diagnostic challenge of negative plain radiography in the context of a previously ambulatory patient is increasing with the rise in geriatric trauma. These patients are often diagnosed with small undisplaced fractures of the pelvis and femur which may not alter management. This study aims to ass...

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Autores principales:	Thomas Gatt, Daniel Cutajar, Lara Borg, Ryan Giordmaina
Formato:	article
Lenguaje:	EN
Publicado:	Hindawi Limited 2021
Materias:	Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/6077ffdfd5924202ad248065a38f8050
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spelling	oai:doaj.org-article:6077ffdfd5924202ad248065a38f80502021-11-29T00:56:34ZThe Necessity of CT Hip Scans in the Investigation of Occult Hip Fractures and Their Effect on Patient Management2090-347210.1155/2021/8118147https://doaj.org/article/6077ffdfd5924202ad248065a38f80502021-01-01T00:00:00Zhttp://dx.doi.org/10.1155/2021/8118147https://doaj.org/toc/2090-3472The diagnostic challenge of negative plain radiography in the context of a previously ambulatory patient is increasing with the rise in geriatric trauma. These patients are often diagnosed with small undisplaced fractures of the pelvis and femur which may not alter management. This study aims to assess the frequency at which computed tomography (CT) hip scans altered patient management and whether two X-ray projections of the hip affected fracture detection rate. All CT hip scans performed over a three-year period were identified retrospectively. Only CT hips pertaining to the identification of occult fractures were included in the study. A total of 447 (63.6%) CT hips were performed to exclude an occult fracture, which was only detected in 108 (24.1%) of the scans requested. The majority were subcapital (n = 58, 53.7%) or intertrochanteric (n = 39, 36.1%). There was no significant difference between fracture detection rates when comparing one and two views of the pelvis. 82.4% (n = 89) of occult hip fractures were managed operatively. CT imaging led to a change in patient management in 20% of cases. The frequency at which CT scan detects and alters management in occult hip fractures confirms the justification for its use. Increasing the number of X-ray projection views does not decrease the reliance on CT. Pelvic ring fractures are common in nonambulatory patients following trauma, and if confirmed on initial imaging, subsequent imaging to exclude a concurrent occult hip is unnecessary. The focus of further research should be towards the development of investigation algorithms which decrease the reliance on CT and defining the optimal surgical criteria for occult hip fractures.Thomas GattDaniel CutajarLara BorgRyan GiordmainaHindawi LimitedarticleOrthopedic surgeryRD701-811ENAdvances in Orthopedics, Vol 2021 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Orthopedic surgery RD701-811
spellingShingle	Orthopedic surgery RD701-811 Thomas Gatt Daniel Cutajar Lara Borg Ryan Giordmaina The Necessity of CT Hip Scans in the Investigation of Occult Hip Fractures and Their Effect on Patient Management
description	The diagnostic challenge of negative plain radiography in the context of a previously ambulatory patient is increasing with the rise in geriatric trauma. These patients are often diagnosed with small undisplaced fractures of the pelvis and femur which may not alter management. This study aims to assess the frequency at which computed tomography (CT) hip scans altered patient management and whether two X-ray projections of the hip affected fracture detection rate. All CT hip scans performed over a three-year period were identified retrospectively. Only CT hips pertaining to the identification of occult fractures were included in the study. A total of 447 (63.6%) CT hips were performed to exclude an occult fracture, which was only detected in 108 (24.1%) of the scans requested. The majority were subcapital (n = 58, 53.7%) or intertrochanteric (n = 39, 36.1%). There was no significant difference between fracture detection rates when comparing one and two views of the pelvis. 82.4% (n = 89) of occult hip fractures were managed operatively. CT imaging led to a change in patient management in 20% of cases. The frequency at which CT scan detects and alters management in occult hip fractures confirms the justification for its use. Increasing the number of X-ray projection views does not decrease the reliance on CT. Pelvic ring fractures are common in nonambulatory patients following trauma, and if confirmed on initial imaging, subsequent imaging to exclude a concurrent occult hip is unnecessary. The focus of further research should be towards the development of investigation algorithms which decrease the reliance on CT and defining the optimal surgical criteria for occult hip fractures.
format	article
author	Thomas Gatt Daniel Cutajar Lara Borg Ryan Giordmaina
author_facet	Thomas Gatt Daniel Cutajar Lara Borg Ryan Giordmaina
author_sort	Thomas Gatt
title	The Necessity of CT Hip Scans in the Investigation of Occult Hip Fractures and Their Effect on Patient Management
title_short	The Necessity of CT Hip Scans in the Investigation of Occult Hip Fractures and Their Effect on Patient Management
title_full	The Necessity of CT Hip Scans in the Investigation of Occult Hip Fractures and Their Effect on Patient Management
title_fullStr	The Necessity of CT Hip Scans in the Investigation of Occult Hip Fractures and Their Effect on Patient Management
title_full_unstemmed	The Necessity of CT Hip Scans in the Investigation of Occult Hip Fractures and Their Effect on Patient Management
title_sort	necessity of ct hip scans in the investigation of occult hip fractures and their effect on patient management
publisher	Hindawi Limited
publishDate	2021
url	https://doaj.org/article/6077ffdfd5924202ad248065a38f8050
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The Necessity of CT Hip Scans in the Investigation of Occult Hip Fractures and Their Effect on Patient Management

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