R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, MD 21201, USA.
J Orthop Trauma. 2013 Jun;27(6):325-30. doi: 10.1097/BOT.0b013e318271b6c8.
Femoral neck fractures that are associated with femoral shaft fractures have historically been associated with high rates of missed diagnosis. Despite the potentially serious consequences of a missed femoral neck fracture, little work has been conducted to rigorously evaluate the ability of commonly used imaging studies to detect such fractures. Our hypothesis was that axial-view computed tomography is superior to plain radiography at detecting femoral neck fractures.
Blinded assessment of a randomized image set that included axial-view computed tomographic scans of the pelvis, anteroposterior-view radiographs of the pelvis, and anteroposterior-view radiographs of the femur.
Academic trauma center.
Twenty-eight patients who had femoral shaft fractures with femoral neck fractures and 60 patients who had femoral shaft fractures without femoral neck fractures.
Images that were stripped of demographic data were independently viewed in random order on computer workstations by 5 trauma fellowship-trained orthopaedic surgeons who were blinded to treatment and diagnosis.
Sensitivity, specificity, positive post-test probability, and 1 minus negative post-test probability were calculated for diagnosing femoral neck fracture based on each image type.
Interobserver reliability showed "substantial agreement" (kappa > 0.65) for all imaging modalities, indicating that the surgeons had a high level of agreement. All 3 imaging sets had high specificity (>94%) and 1 minus negative post-test probability (>95%) but had poor sensitivity (<65%) and positive post-test probability (<58%). False positives and false negatives were equally likely for all imaging modalities (P > 0.2).
Plain radiography and computed tomography have rates of missed femoral neck fractures that are similar and substantial, with a sensitivity of only 56%-64%. Our data emphasize the importance of intraoperative and postoperative imaging in detecting nondisplaced femoral neck fractures in association with femoral shaft fractures.
股骨颈骨折伴股骨干骨折历来与高漏诊率相关。尽管漏诊股骨颈骨折可能会产生严重后果，但很少有研究严格评估常用影像学检查检测此类骨折的能力。我们的假设是轴位 CT 比骨盆正位 X 线片和股骨正侧位 X 线片更能检测股骨颈骨折。
对包括骨盆轴位 CT 扫描、骨盆正位 X 线片和股骨正侧位 X 线片的随机图像集进行盲法评估。
学术创伤中心。
28 例股骨干骨折伴股骨颈骨折患者和 60 例股骨干骨折不伴股骨颈骨折患者。
将去除人口统计学数据的图像以随机顺序在计算机工作站上由 5 名接受过创伤 fellowship培训的骨科医生独立查看，这些医生对治疗和诊断均不知情。
根据每种图像类型，计算诊断股骨颈骨折的敏感度、特异度、阳性预测值和 1 减阴性预测值。
所有影像学检查均显示观察者间一致性“高度一致”（kappa > 0.65），表明外科医生具有高度一致性。所有 3 种影像学检查均具有高特异度（>94%）和 1 减阴性预测值（>95%），但敏感度低（<65%）和阳性预测值低（<58%）。所有影像学检查的假阳性和假阴性发生几率相当（P > 0.2）。
平片和 CT 检查漏诊股骨颈骨折的几率相似且较大，敏感度仅为 56%-64%。我们的数据强调了术中及术后影像学检查在检测与股骨干骨折相关的无移位股骨颈骨折中的重要性。
