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Magnetic resonance imaging for verifying hip fracture diagnosis why, when and how?

Pejic, Ana; Hansson, Susanne LU and Rogmark, Cecilia LU (2017) In Injury 48(3). p.687-691
Abstract

Introduction: Hip fractures are commonly diagnosed by plain radiography. When a patient presents with negative radiographs and high clinical suspicion of fracture, guidelines recommend proceeding with magnetic resonance imaging (MRI) to diagnose the patient. The aim of this study was to assess the use of MRI in diagnosing hip fractures following trauma to the hip and describe clinical outcome after MRI-diagnosed hip fractures. The perspective was to develop new recommendations for MRI use. Materials and methods: 616 patients at a university hospital fulfilled the inclusion criteria of having an MRI scan of the hip following trauma between the years of 2005 and 2014. Data was collected from the patients' medical records. Results: The... (More)

Introduction: Hip fractures are commonly diagnosed by plain radiography. When a patient presents with negative radiographs and high clinical suspicion of fracture, guidelines recommend proceeding with magnetic resonance imaging (MRI) to diagnose the patient. The aim of this study was to assess the use of MRI in diagnosing hip fractures following trauma to the hip and describe clinical outcome after MRI-diagnosed hip fractures. The perspective was to develop new recommendations for MRI use. Materials and methods: 616 patients at a university hospital fulfilled the inclusion criteria of having an MRI scan of the hip following trauma between the years of 2005 and 2014. Data was collected from the patients' medical records. Results: The annual number of MRIs increased over the ten-year period. Out of 616 MRI scans 228 (37%) showed fracture of the hip with a dominance of trochanteric fractures, 185 (30%) revealed pelvic fracture and 183 (29%) were negative. No patient with acute pelvic fracture had associated fracture of the hip. The main reason to proceed with MRI was a strong clinical suspicion of fracture in patients with negative initial radiographs. Amongst the 228 patients with fracture, 187 (82%) were treated operatively. Of patients with hip fracture, 90 (39%) patients suffered a general complication and 11 (5%) had hip complications. The complication rate of patients with fracture on MRI was compared to that of a cohort of general hip fracture patients at our hospital. No significant difference in twelve months' survival or general complications could be found, but the MRI group had a significantly lower hip complication rate. Conclusion: The diagnosis set by MRI, with high share of pelvic fractures or no fracture, reflects the difficulty in differential diagnosing this group of patients. The rate of occult hip fractures was low and patients with pelvic fractures already known from X-ray did not have additional hip fractures. We found an increase in the annual number of MRIs during the 10-year-period. MRI-diagnosed hip fracture patients do not suffer more complications than the regular hip fracture patient.

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author
organization
publishing date
type
Contribution to journal
publication status
published
keywords
Complications, Diagnostic imaging, Hip fracture, Magnetic resonance imaging, Occult hip fracture
in
Injury
volume
48
issue
3
pages
687 - 691
publisher
Elsevier
external identifiers
  • scopus:85009892181
  • wos:000398097700017
ISSN
0020-1383
DOI
10.1016/j.injury.2017.01.025
language
English
LU publication?
yes
id
8ab084e9-3c4c-423e-9cb7-2fb76d482e26
date added to LUP
2017-02-01 13:50:31
date last changed
2018-01-07 11:47:28
@article{8ab084e9-3c4c-423e-9cb7-2fb76d482e26,
  abstract     = {<p>Introduction: Hip fractures are commonly diagnosed by plain radiography. When a patient presents with negative radiographs and high clinical suspicion of fracture, guidelines recommend proceeding with magnetic resonance imaging (MRI) to diagnose the patient. The aim of this study was to assess the use of MRI in diagnosing hip fractures following trauma to the hip and describe clinical outcome after MRI-diagnosed hip fractures. The perspective was to develop new recommendations for MRI use. Materials and methods: 616 patients at a university hospital fulfilled the inclusion criteria of having an MRI scan of the hip following trauma between the years of 2005 and 2014. Data was collected from the patients' medical records. Results: The annual number of MRIs increased over the ten-year period. Out of 616 MRI scans 228 (37%) showed fracture of the hip with a dominance of trochanteric fractures, 185 (30%) revealed pelvic fracture and 183 (29%) were negative. No patient with acute pelvic fracture had associated fracture of the hip. The main reason to proceed with MRI was a strong clinical suspicion of fracture in patients with negative initial radiographs. Amongst the 228 patients with fracture, 187 (82%) were treated operatively. Of patients with hip fracture, 90 (39%) patients suffered a general complication and 11 (5%) had hip complications. The complication rate of patients with fracture on MRI was compared to that of a cohort of general hip fracture patients at our hospital. No significant difference in twelve months' survival or general complications could be found, but the MRI group had a significantly lower hip complication rate. Conclusion: The diagnosis set by MRI, with high share of pelvic fractures or no fracture, reflects the difficulty in differential diagnosing this group of patients. The rate of occult hip fractures was low and patients with pelvic fractures already known from X-ray did not have additional hip fractures. We found an increase in the annual number of MRIs during the 10-year-period. MRI-diagnosed hip fracture patients do not suffer more complications than the regular hip fracture patient.</p>},
  author       = {Pejic, Ana and Hansson, Susanne and Rogmark, Cecilia},
  issn         = {0020-1383},
  keyword      = {Complications,Diagnostic imaging,Hip fracture,Magnetic resonance imaging,Occult hip fracture},
  language     = {eng},
  number       = {3},
  pages        = {687--691},
  publisher    = {Elsevier},
  series       = {Injury},
  title        = {Magnetic resonance imaging for verifying hip fracture diagnosis why, when and how?},
  url          = {http://dx.doi.org/10.1016/j.injury.2017.01.025},
  volume       = {48},
  year         = {2017},
}