Abstract
A clinical evaluation of the effect of MRI scan to bring about a change in surgical management of elderly patients who present with hip fracture with no history of trauma or a suspicious looking lesion on x-rays. Many of these patients present with or without history of previous malignancy or bone disorder.
We evaluated that if the delay in treatment within 36 hours as per national guide lines is justified to benefit patients.
Methods
A clinical review of six hundred hip fracture patients where one hundred and four patients who had MRI scan of hip for fracture with either no history of trauma or a fracture with suspected pathological features with or without history of malignancy or bone disorder.
The final outcome of hundred patients who had MRI scans 32 male and 68 female with median age of 65 years. Four patients were excluded as were unable to tolerate the MRI scan.
Statistical analysis software SAS/STAT® was used to conduct data collation and analyses.
A further radiological analysis of MRI scans with positive lesion to the plain X-rays to correlate the finding of a lesion on femoral side on MRI scan to a lesion on acetabular side.
Results
Out of hundred patients who had MRI scan for a suspected metastatic or pathological lesion only 12 showed a metastatic lesion despite the fact 31 had previous history of malignancy, CI 4.03; 101.91, P < 0.0003. No primary lesion detected in any patient.
We also found if the acetabular side was not seen to be involved on pain x-ray, MRI scan did not detect any acetabular lesion, contingency coefficient 0.5632, P < .0001.
Conclusion
Delay in surgery to obtain an MRI scan does not change any management plans and hence best avoided for benefit of patients and compliance with guide lines.
