Posttraumatic painful hip: sonography as a screening test for occult hip fractures.
OBJECTIVE
Nondisplaced hip fractures may be radiographically occult and require magnetic resonance imaging (MRI) or bone scintigraphy for diagnosis. Both examinations are expensive and are not readily available in many hospitals. Our objective was to evaluate sonography as a screening tool for occult hip fractures in posttraumatic painful hips in elderly patients.


METHODS
We prospectively evaluated 30 patients (mean age, 73 years), who were admitted for painful hips after having low-energy trauma with nondiagnostic hip radiographs. After inclusion, patients underwent sonography of both hips for signs of injury. After completion of the sonographic examination and analysis of the results, patients underwent MRI of both hips. The sonographic findings were compared with the MRI findings, which served as the reference standard for accurate detection of a hip fracture.


RESULTS
Ten hip fractures were diagnosed by MRI. Sonography showed trauma-related changes in all of those patients and in 7 additional patients, 3 of whom had pubic fractures. Sonography correctly identified 13 patients without hip fractures. The sensitivity of sonography was found to be 100%, whereas the specificity for hip fractures was 65%.


CONCLUSIONS
Sonography for posttraumatic hip pain with negative radiographic findings did not result in a single missed hip fracture. Therefore, sonography may serve as an effective screening tool, mandating MRI only for cases with positive findings, whereas patients with negative sonographic findings need no further investigation. Sonography may therefore be very useful in hospitals around the world, where MRI may not be readily affordable or available.
Department of Orthopedics, Hadassah Hebrew University Medical Center, Kyriat Hadassah, 91120 Jerusalem, Israel. oris@hadassah.org.il
Ori
O
Safran
Vladimir
V
Goldman
Yaakov
Y
Applbaum
Charles
C
Milgrom
Ronald
R
Bloom
Amos
A
Peyser
David
D
Kisselgoff
D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000000981:diagnostic imaging* / Q000209:etiology*; D005260:Female; D006620:Hip Fractures / Q000150:complications* / Q000000981:diagnostic imaging*; D025981:Hip Injuries / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*