X-Ray Inefficiencies in Detecting Hip and Pelvic Fractures
X-Ray Inefficiencies in Detecting Hip and Pelvic Fractures
Kirby MW, Spritzer C
AJR. 2010;194:1054-1060
Hip and pelvic fractures can be significant sources of morbidity and mortality in the geriatric population. This retrospective study evaluated the sensitivity of radiography in detecting hip and pelvic fractures in patients who presented to the hospital emergency department with hip pain and/or suspected hip or pelvic trauma. Radiographs from the hospital emergency department were reviewed by 2 musculoskeletal radiologists from 2005 to 2008. A total of 92 patients and 97 examinations were included in the study: 14% of patients with normal radiograph findings were found to have evidence of a hip or pelvic fracture on magnetic resonance imaging (MRI), 16% of patients with abnormal radiograph findings had MRI results showing 12 additional pelvic fractures not seen on radiographs, and 12% of patients with possible fractures noted on radiographs showed no fractures on MRI. In this particular study, sacral and pubic ramus fractures were the most common types of fractures found on MRI. Furthermore, MRI revealed soft-tissue pathologic findings that could be clinically relevant in 73% of patients with no evidence of fracture on MRI.
This study highlights the limitations of radiography in detecting hip or pelvic pathologic findings, including fractures, as well as soft-tissue pathologic findings, in acute settings, such as a hospital emergency department. Other recent studies have also noted superior sensitivity of MRI in detecting hip and pelvic fractures over plain film radiography. In all of these situations, however, clinical judgment should guide the need to pursue further diagnostic imaging.
Abstract
Radiographic Detection of Hip and Pelvic Fractures in the Emergency Department
Kirby MW, Spritzer C
AJR. 2010;194:1054-1060
Article Summary
Hip and pelvic fractures can be significant sources of morbidity and mortality in the geriatric population. This retrospective study evaluated the sensitivity of radiography in detecting hip and pelvic fractures in patients who presented to the hospital emergency department with hip pain and/or suspected hip or pelvic trauma. Radiographs from the hospital emergency department were reviewed by 2 musculoskeletal radiologists from 2005 to 2008. A total of 92 patients and 97 examinations were included in the study: 14% of patients with normal radiograph findings were found to have evidence of a hip or pelvic fracture on magnetic resonance imaging (MRI), 16% of patients with abnormal radiograph findings had MRI results showing 12 additional pelvic fractures not seen on radiographs, and 12% of patients with possible fractures noted on radiographs showed no fractures on MRI. In this particular study, sacral and pubic ramus fractures were the most common types of fractures found on MRI. Furthermore, MRI revealed soft-tissue pathologic findings that could be clinically relevant in 73% of patients with no evidence of fracture on MRI.
Viewpoint
This study highlights the limitations of radiography in detecting hip or pelvic pathologic findings, including fractures, as well as soft-tissue pathologic findings, in acute settings, such as a hospital emergency department. Other recent studies have also noted superior sensitivity of MRI in detecting hip and pelvic fractures over plain film radiography. In all of these situations, however, clinical judgment should guide the need to pursue further diagnostic imaging.
Abstract
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