Abstract
Introduction
Occult hip fractures occur in 3% of cases. Delay in treatment results in significantly increased morbidity and mortality. NICE guidelines recommend cross-sectional imaging within 24 hours and surgery on the day of, or day after, admission. MRI was the standard imaging modality for suspected occult hip fractures in our institution, but since January 2013, we have switched to multi-detector CT (MDCT) scan.
Our aims were to investigate whether MDCT has improved the times to diagnosis and surgery; and whether it resulted in missed hip fractures.
Patients/Materials & Methods
Retrospective review of a consecutive series of patients between 01/01/2013 and 31/08/2014 who had MDCT scan for suspected occult hip fracture. Missed fracture was defined as a patient re-presenting with hip fracture within six weeks of a negative scan. A comparative group of consecutive MRI scans from 01/01/2011 to 31/12/2012 was used.
Results
Seventy-three MDCTs and 70 MRIs were included. MDCT identified nine hip fractures and other fractures in 27 patients. Mean time to scan for MDCT was 13 hours 37 minutes compared with 53 hours 36 minutes for MRI scan (p<0.001). 88.5% of MDCTs were performed within 24 hours compared with 33.3% of MRIs.
Nine and 16 patients required surgery in the MDCT and MRI groups, respectively. Mean time to surgery for MDCT was 50 hours 41 minutes compared with 223 hours 21 minutes for MRI scan (p = 0.25).
There were no missed hip fractures in the patients with negative MDCT scan.
Discussion
MDCT scan has led to a significant reduction in time to diagnosis, and a large reduction in time to surgery. MDCT did not miss any hip fractures.
Conclusion
We advocate the use of MDCT over MRI in suspected occult hip fractures as it is cheaper, quicker, and more readily available; and does not result in missed hip fractures.
