Abstract
Background
The anterior-posterior (AP) pelvis radiograph is crucial for diagnosis of neck of femur (NOF) fractures, especially as this is one of the commonest fractures in the elderly population. Anecdotally we found that initial AP pelvis radiographs for these suspected fractures did not always exhibit the bones sufficiently. Repeat radiographs were needed, leading to delays in diagnosis, treatment, and repeated radiation exposure. Missed diagnoses can have significant consequences for this patient group. We assessed how many initial AP pelvis radiographs taken for suspected NOF fracture fitted criteria for adequate diagnostic imaging.
Methods
A retrospective study was carried out assessing the initial AP pelvis radiograph done for each patient presenting to our dedicated NOF unit with suspected NOF fracture for 1st June – 31st July 2014. European Guidelines for Diagnostic Imaging were used as the benchmark. Each radiograph was scored out of six, one for each criteria fulfilled. Guidelines deemed images scoring ≤3 as inadequate.
Results
76 images were assessed with mean patient age 85 years. 51.3% of images scored ≤3 and mean score was 3.59. The least-met criterion was “sharp reproduction of sacrum and vertebral foramina” (26.3%). Crucially only 52.6% achieved “visually sharp reproduction of spongiosa, trochanters and corticalis of both femurs”, important in diagnosis of NOF fractures.
Conclusion
More than half initial AP pelvis radiographs taken for suspected NOF fracture were inadequate based on European Guidelines at a dedicated NOF unit. Part of the difficulty can be attributed to challenging patient demographics, however adequate initial radiographs should be aimed for, as repeat radiographs can lead to delays in diagnosis and treatment as well as repeated radiation exposure. Missed diagnoses can have significant consequences for this patient group; we particularly recommend care to be taken to sharply visualise the trochanters and proximal femora to avoid missing subtle fractures.
