title: Occult fractures of the proximal femur: imaging diagnosis and management of 82 cases in a regional trauma center.
abstract: BACKGROUND
  Occult hip fractures are often difficult to identify in busy trauma units. We aimed to present our institutions experience in the diagnosis and treatment of occult fractures around the hip and to help define a clinical and radiological management algorithm.
  
  
  METHODS
  We conducted a seven-year retrospective hospital medical record analysis. The electronic database was searched for ICD-10 CM codes S72.0 and S72.1 used for proximal femoral fractures upon patient discharge. We identified 34 (4.83 %) femoral neck fractures and 48 (4.42 %) trochanteric fractures labeled as occult.
  
  
  RESULTS
  The majority of the cases were diagnosed by primary MRI scan (57.4 %) and 12 were diagnosed by emergency CT scan (14.6 %). For the remaining cases the final diagnosis was confirmed by 72 h CT scan in 9 patients (representing 39 % of the false negative cases) or by MRI in the rest of 14 patients. MRI was best at detecting incomplete pertrochanteric fracture patterns (13.45 % of total) and incomplete fractures of the greater trochanter (3.65 % of total) respectively. It also detected the majority of Garden I femoral neck fractures (20.7 % of total). CT scanning accurately detected 100 % of Garden 2 fractures (2.44 %) and 25 % (3.65 %) of the complete pertrochanteric fractures (false negative 25 %).
  
  
  CONCLUSIONS
  Occult fractures should be suspected in all patients with traumatic onset of hip pain that is inconsistent with normal radiographic findings. MRI is the golden standard but not as readily available not as cheap and not quite as quick to perform as as a CT scan. The latter which in turn can provide falsely negative results in the first 24 h. Improved imaging protocols could expedite management and improve treatment.
authors.affiliation: I-st Clinic of Orthopedics and Trauma, Pius Brinzeu Emergency Clinical County Hospital, 10 I. Bulbuca Blvd, 300737 Timisoara, Romania ; Victor Babes University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timişoara, Romania.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Deleanu
authors.affiliation: I-st Clinic of Orthopedics and Trauma, Pius Brinzeu Emergency Clinical County Hospital, 10 I. Bulbuca Blvd, 300737 Timisoara, Romania ; Victor Babes University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timişoara, Romania.
authors.forename: Radu
authors.initials: R
authors.lastname: Prejbeanu
authors.affiliation: Aristotle University Medical School, 54124 Thessaloniki, Greece.
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Tsiridis
authors.affiliation: I-st Clinic of Orthopedics and Trauma, Pius Brinzeu Emergency Clinical County Hospital, 10 I. Bulbuca Blvd, 300737 Timisoara, Romania ; Victor Babes University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timişoara, Romania.
authors.forename: Dinu
authors.initials: D
authors.lastname: Vermesan
authors.affiliation: I-st Clinic of Orthopedics and Trauma, Pius Brinzeu Emergency Clinical County Hospital, 10 I. Bulbuca Blvd, 300737 Timisoara, Romania.
authors.forename: Dan
authors.identifier: 0000-0002-9001-9711
authors.initials: D
authors.lastname: Crisan
authors.affiliation: I-st Clinic of Orthopedics and Trauma, Pius Brinzeu Emergency Clinical County Hospital, 10 I. Bulbuca Blvd, 300737 Timisoara, Romania.
authors.forename: Horia
authors.initials: H
authors.lastname: Haragus
authors.affiliation: St. Pantelimon Clinical Emergency Hospital, 340 - 342 Pantelimon Road, Sector 2, 033092 Bucharest, Romania ; Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania.
authors.forename: Vlad
authors.initials: V
authors.lastname: Predescu
authors.affiliation: Victor Babes University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timişoara, Romania ; Department of Radiology, Pius Brinzeu Emergency Clinical County Hospital, 10 I. Bulbuca Blvd, 300737 Timisoara, Romania.
authors.forename: Florin
authors.initials: F
authors.lastname: Birsasteanu
keywords: CT scan; Fracture; Hip; MRI; Occult; X-ray