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Bilateral occult hip fracture

Published online by Cambridge University Press:  11 May 2015

Willis B. Grad*
Affiliation:
Emergency Department, Jewish General Hospital, Montreal, QC
Nicholas M. Desy
Affiliation:
Orthopedic surgery residency program, Division of Orthopedic Surgery, McGill University, Montreal, QC
*
Emergency Department, Jewish General Hospital, 3755 Côte Ste, Catherine Rd, Montréal, QC H3T 1E2; willis.grad@mcgill.ca.

Abstract

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One of the most common acute injuries seen in the emergency department is the hip fracture. This injury is usually diagnosed by plain radiographs, however these fractures are sometimes not obviously apparent. Occult hip fractures present a pitfall for emergency department physicians. We present a case of a patient who sustained bilateral occult hip fractures. We review the epidemiology of the condition, examine what diagnostic studies are available that may help the physician avoid missing the occult hip fracture and what the literature tells us about the utility of each of these modalities. The prognosis of the occult hip fracture along with options for treatment is also discussed.

Type
Case Report • Rapport de cas
Copyright
Copyright © Canadian Association of Emergency Physicians 2012

References

REFERENCES

1.Leslie, WD, O’Donnell, S, Jean, S, et al. Trends in hip fracture rates in Canada. JAMA 2009;302:883–9, doi:10.1001/jama.2009.1231.Google Scholar
2.Wiktorowicz, ME, Goeree, R, Papaioannou, A, et al. Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int 2001;12:271–8, doi:10.1007/s001980170116.CrossRefGoogle ScholarPubMed
3.Papadimitropoulos, EA, Coyte, PC, Josse, RG, et al. Current and projected rates of hip fracture in Canada. Can Med Assoc J 1997;157:1357–63.Google ScholarPubMed
4.Cooper, C, Atkinson, EJ, Jacobsen, SJ, et al. Population-based study of survival after osteoporotic fractures. Am J Epidemiol 1993;137:1001–5.Google Scholar
5.Leibson, CL, Tosteson, AN, Gabriel, SE, et al. Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J AmGeriatr Soc 2002;50:1644–50, doi:10.1046/j.1532-5415.2002.50455.x.CrossRefGoogle ScholarPubMed
6.Magaziner, J, Lydick, E, Hawkes, W, et al. Excess mortality attributable to hip fracture in white women aged 70 years and older. Am J Public Health 1997;87:1630–6, doi:10.2105/AJPH.87.10.1630.CrossRefGoogle ScholarPubMed
7.Magaziner, J, Hawkes, W, Hebel, JR, et al. Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 2000;55:M498–507, doi:10.1093/gerona/55.9.M498.CrossRefGoogle ScholarPubMed
8.Oka, M, Monu, J. Prevalence and patterns of occult hip fractures and mimics revealed by MRI. AJR Am J Roentgenol 2004;182:283–8.CrossRefGoogle ScholarPubMed
9.Kim, KC, Ha, YC, Kim, TY, et al. Initially missed occult fractures of the proximal femur in elderly patients: implications for need of operation and their morbidity. Arch Orthop Trauma Surg 2010;130:915–20, doi:10.1007/s00402-010-1105-4.CrossRefGoogle ScholarPubMed
10.Deutsch, AL, Mink, JH, Waxman, AD. Occult fractures of the proximal femur: MR imaging. Radiology 1989;170(1 Pt 1):113–6.CrossRefGoogle ScholarPubMed
11.Galloway, HR, Meikle, GR, Despois, M. Patterns of injury in patients with radiographic occult fracture of neck of femur as determined by magnetic resonance imaging. Australas Radiol 2004;48:21–4, doi:10.1111/j.1440-1673.2004.01236.x.CrossRefGoogle Scholar
12.Nachtrab, O, Cassar-Pullicino, VN, Lalam, R, et al. Role of MRI in hip fractures, including stress fractures, occult fractures, avulsion fractures. Eur J Radiol. [Epub 2011 Apr 28]Google ScholarPubMed
13.Fiechtl, JF, Fitch, RW. Femur and hip. In: Marx, JA, editor. Rosen’s emergency medicine: concepts and clinical practice. 7th ed. Philadelphia: Mosby; 2009. p. 626.Google Scholar
14.Lubovsky, O, Liebergall, M, Matin, Y, et al. Early diagnosis of occult hip fractures MRI versus CT scan. Injury 2005;36:788–92, doi:10.1016/j.injury.2005.01.024.Google Scholar
15.Perron, AD, Miller, MD, Brady, WJ. Orthopedic pitfalls in the ED: radiographically occult hip fracture. Am J Emerg Med 2002;20:234–7, doi:10.1053/ajem.2002.33007.CrossRefGoogle ScholarPubMed
16.Beloosesky, Y, Hershkovitz, A, Guz, A, et al. Clinical characteristics and long-term mortality of occult hip fracture elderly patients. Injury 2010;41:343–7, doi:10.1016/j.injury.2009.08.017.CrossRefGoogle ScholarPubMed
17.Verbetten, KM, Hermann, KL, Hasselqvist, M. The advantages of MRI in the detection of occult hip fractures. Eur Radiol 2005;15:165–9, doi:10.1007/s00330-004-2421-2.CrossRefGoogle Scholar
18.Adams, SB Jr, Mayer, SW, Hamming, MG, et al. Femoral neck fracture in association with low-energy pelvic ring fractures in an elderly patient. Am J Emerg Med 2010;28:746.e1-3, doi:10.1016/j.ajem.2009.09.026.Google Scholar
19.Parker, MJ. Missed hip fractures. Arch Emerg Med 1992;9:23–7.Google Scholar
20.Rizzo, PF, Gould, ES, Lyden, JP, et al. Diagnosis of occult fractures about the hip. J Bone Joint Surg Am 1993;75:395401.Google Scholar
21.Feldman, D, Zuckerman, J, Frankel, VH. Geriatric hip fractures: preoperative decision making. J Musculoskel Med 1990;7:15, doi:10.1007/BF02697334.Google Scholar
22.Eastwood, HD. Delayed diagnosis of femoral-neck fractures in the elderly. Age Ageing 1987;16:378–82, doi:10.1093/ageing/16.6.378.CrossRefGoogle ScholarPubMed
23.Fairclough, J, Colhoun, E, Johnston, D, et al. Bone scanning for suspected hip fractures. A prospective study in elderly patients. J Bone Joint Surg Br 1987;69:251–3.CrossRefGoogle ScholarPubMed
24.Pathak, G, Parker, MJ, Pryor, GA. Delayed diagnosis of femoral neck fractures. Injury 1997;28:299301, doi:10.1016/S0020-1383(96)00198-2.Google Scholar
25.Pandey, R, McNally, E, Ali, A, et al. The role of MRI in the diagnosis of occult hip fractures. Injury 1998;29:61–3, doi:10.1016/S0020-1383(97)00165-4.CrossRefGoogle ScholarPubMed
26.Lee, YP, Griffith, JF, Antonio, GE, et al. Early magnetic resonance imaging of radiographically occult osteoporotic fractures of the femoral neck. Hong Kong Med J 2004;10:271–5.Google ScholarPubMed
27.Zuckerman, JD. Hip fracture. N Engl J Med 1996;334:1519–25, doi:10.1056/NEJM199606063342307.CrossRefGoogle ScholarPubMed
28.Quinn, SF, McCarthey, JL. Prospective evaluation of patients with suspected hip fractures and indeterminate radiographs—use of T1-weighted MR images. Radiology 1993;187:469–71.Google Scholar
29.Rubin, SJ, Marquardt, JD, Gottlieb, RH, et al. Magnetic resonance imaging: a cost- effective alternative to bone scintigraphy in the evaluation of patients with suspected hip fractures. Skeletal Radiol 1998;28:199204, doi:10.1007/s002560050365.CrossRefGoogle Scholar
30.Mlinek, EJ, Clark, KC, Walker, CW. Limited magnetic resonance imaging in the diagnosis of occult hip fractures. Am J Emerg Med 1998;16:390–2, doi:10.1016/S0735-6757(98)90136-X.Google Scholar
31.Haramati, N, Staron, RB, Barax, C, et al. Magnetic resonance imaging of occult fractures of the proximal femur. Skeletal Radiol 1994;23:1922.CrossRefGoogle ScholarPubMed
32.Holder, LE, Schwarz, C, Wernicke, PG, et al. Radionuclide bone imaging in the early detection of fractures of the proximal femur (hip); multifactorial analysis. Radiology 1990;174:509–15.Google Scholar
33.CTV News. Canada’s isotope shortage still a crisis: doctors. Available at: http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20091218/holiday_isotopes_100103/20100103?hub=TopStoriesV2 (accessed June 30, 2011).Google Scholar
34.Dominguez, S, Liu, P, Roberts, C, et al. Prevalence of traumatic hip and pelvic fractures in patients with suspected hip fracture and negative initial standard radiographs—a study of emergency department patients. Acad Emerg Med 2005;12:366–9.CrossRefGoogle ScholarPubMed
35.Lim, KBL, Eng, AKH, Chng, SM, et al. Limited magnetic resonance imaging (MRI) and the occult hip fracture. Ann Acad Med Singapore 2002;31:607–10.Google ScholarPubMed
36.Cannon, J, Silvestri, S, Munro, M. Imaging choices in occult hip fracture. J Emerg Med 2009;37:144–52, doi:10.1016/j.jemermed.2007.12.039.CrossRefGoogle ScholarPubMed
37.Egund, N, Nilsson, LT, Wingstrand, H, et al. CT scans and lipohaemarthrosis in hip fractures. J Bone Joint Surg Br 1990;72:379–82.Google Scholar
38.Cabarrus, MC, Ambekar, A, Lu, Y, et al. MRI and CT of insufficiency fractures of the pelvis and proximal femur. AJR Am J Roentgenol 2008;191:9951001, doi:10.2214/AJR.07.3714.Google Scholar
39.Hayes, CW, Balkissoon, AR. Current concepts in imaging of the pelvis and hip. Orthop Clin North Am 1997;28:617–42,doi:10.1016/S0030-5898(05)70310-2.CrossRefGoogle ScholarPubMed
40.Helman, A, host. Episode 1: Occult fractures & dislocations [podcast]. Emergency medicine cases. Available at: http://www.emergencymedicinecases.com/2010/03/08/episode-1-orthopaedic-emergencies/ (accessed July 9, 2011).Google Scholar
41.Safran, O, Goldman, V, Applbaum, Y, et al. Posttraumatic painful hip: sonography as a screening test for occult hip fractures. J Ultrasound Med 2009;28:1447–52.Google Scholar
42.Chana, R, Noorani, A, Ashwood, N, et al. The role of MRI in the diagnosis of proximal femoral fractures in the elderly. Injury 2006;37:185–9, doi:10.1016/j.injury.2005.07.012.Google Scholar
43.Hossain, C, Barwick, C, Sinha, AK, et al. Is magnetic resonance imaging (MRI) necessary to exclude occult hip fracture? Injury 2007;38:1204–8, doi:10.1016/j.injury.2007.04.023.Google Scholar
44.Sankey, RA, Turner, J, Lee, J, et al. The use of MRI to detect occult fractures of the proximal femur: a study of 102 consecutive cases over a ten-year period. J Bone Joint Surg Br 2009;91:1064–8, doi:10.1302/0301-620X.91B8.21959.Google Scholar
45.Rubin, G, Malka, I, Rozen, N. Should we operate on occult hip fractures? Isr Med Assoc J 2010;12:316“7.Google Scholar
46.Alba, E, Youngberg, R. Occult fractures of the femoral neck. Am J Emerg Med 1992;10:64–8, doi:10.1016/0735-6757(92)90130-P.CrossRefGoogle ScholarPubMed
47.Semunovic, N, Devereaux, PJ, Sprague, S, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ 2010;182:1609–16, doi:10.1503/cmaj.092220.Google Scholar
48.Kim, KC, Ha, YC, Kim, TY, et al. Initially missed occult fractures of the proximal femur in elderly patients: implications for need of operation and their morbidity. Arch Orthop Trauma Surg 2010;130:915–20, doi:10.1007/s00402-010-1105-4.CrossRefGoogle ScholarPubMed