Gatt Thomas, Cutajar Daniel, Borg Lara, Giordmaina Ryan
Department of Orthopaedics and Trauma, Mater Dei Hospital, Msida MSD2090, Malta.
Adv Orthop. 2021 Nov 18;2021:8118147. doi: 10.1155/2021/8118147. eCollection 2021.
The diagnostic challenge of negative plain radiography in the context of a previously ambulatory patient is increasing with the rise in geriatric trauma. These patients are often diagnosed with small undisplaced fractures of the pelvis and femur which may not alter management. This study aims to assess the frequency at which computed tomography (CT) hip scans altered patient management and whether two X-ray projections of the hip affected fracture detection rate. All CT hip scans performed over a three-year period were identified retrospectively. Only CT hips pertaining to the identification of occult fractures were included in the study. A total of 447 (63.6%) CT hips were performed to exclude an occult fracture, which was only detected in 108 (24.1%) of the scans requested. The majority were subcapital ( = 58, 53.7%) or intertrochanteric ( = 39, 36.1%). There was no significant difference between fracture detection rates when comparing one and two views of the pelvis. 82.4% ( = 89) of occult hip fractures were managed operatively. CT imaging led to a change in patient management in 20% of cases. The frequency at which CT scan detects and alters management in occult hip fractures confirms the justification for its use. Increasing the number of X-ray projection views does not decrease the reliance on CT. Pelvic ring fractures are common in nonambulatory patients following trauma, and if confirmed on initial imaging, subsequent imaging to exclude a concurrent occult hip is unnecessary. The focus of further research should be towards the development of investigation algorithms which decrease the reliance on CT and defining the optimal surgical criteria for occult hip fractures.
随着老年创伤病例的增加，对于既往能够行走的患者而言，X线平片检查结果为阴性时的诊断难题日益凸显。这些患者常被诊断为骨盆和股骨的无移位小骨折，而这可能并不影响治疗方案。本研究旨在评估计算机断层扫描（CT）髋关节扫描改变患者治疗方案的频率，以及髋关节的两张X线投照影像是否会影响骨折的检出率。回顾性分析了三年内所有进行的CT髋关节扫描。本研究仅纳入了用于识别隐匿性骨折的CT髋关节扫描。共有447例（63.6%）CT髋关节扫描用于排除隐匿性骨折，而在所要求的扫描中仅108例（24.1%）检测到隐匿性骨折。大多数骨折位于股骨头下（n = 58，53.7%）或转子间（n = 39，36.1%）。比较骨盆的一张和两张X线影像时，骨折检出率无显著差异。82.4%（n = 89）的隐匿性髋关节骨折接受了手术治疗。CT成像在20%的病例中导致了患者治疗方案的改变。CT扫描检测并改变隐匿性髋关节骨折治疗方案的频率证实了其应用的合理性。增加X线投照影像的数量并不能减少对CT的依赖。骨盆环骨折在创伤后不能行走的患者中很常见，如果在初始影像检查中得到证实，则无需进行后续影像检查以排除并发的隐匿性髋关节骨折。进一步研究的重点应是开发减少对CT依赖的检查算法，并确定隐匿性髋关节骨折的最佳手术标准。
