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73-year-old woman with a varus-impacted femoral neck fracture. AP radiograph of the right hip (a) demonstrates an impacted femoral neck fracture (arrows) with loss of the normal offset at the femoral head/neck junction, resulting in a decreased angle between the femoral head and neck (dashed line and curved arrow). For treatment purposes, a varus-impacted femoral neck fracture (with the femoral diaphysis directed medially) is considered an unstable fracture, equivalent to a displaced fracture. This was treated with hemiarthroplasty (b)
Source publication
Purpose of Review
To summarize relevant anatomy, imaging, and treatment of hip fractures, and to synthesize a treatment-based approach for description and classification of hip fractures.
Recent Findings
Hip fractures are predominantly seen in the elderly, where they are increasing in incidence, and can substantially reduce healthy life-years. The...
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Background
The complex anatomy of the trochanter and the diversity in mechanisms of injury to it complicate intertrochanteric fracture patterns. Using digital technology, we created three-dimensional (3D) computed tomography (CT) mapping to show the relevant characteristics of intertrochanteric fractures in elderly patients.
Material/Methods
This...
Citations
... CT data can also be sampled to produce multiple radiograph-like slices in different planes (see Fig. 1d-g) or to visualize a fracture without radiographic artifacts such as overlapping fracture edges or hardware [20,21]. In current clinical practice, 3D imaging such as CT and MRI are not routinely performed when a hip fracture can be identified radiographically, but these 3D modalities have a clear role in the diagnosis of suspected occult hip fractures [22]. Conversely, almost half of pelvic fractures are missed on radiographs, suggesting that CT should be routinely performed due to its higher sensitivity in this region [23]. ...
Purpose of review:
This review discusses imaging modalities for fracture repair assessment, with an emphasis on pragmatic clinical and translational use, best practices for implementation, and challenges and opportunities for continuing research.
Recent findings:
Semiquantitative radiographic union scoring remains the clinical gold standard, but has questionable reliability as a surrogate indicator of structural bone healing, particularly in early-stage, complex, or compromised healing scenarios. Alternatively, computed tomography (CT) scanning enables quantitative assessment of callus morphometry and mechanics through the use of patient-specific finite-element models. Dual-energy X-ray absorptiometry (DXA) scanning and radiostereometric analysis (RSA) are also quantitative, but technically challenging. Nonionizing magnetic resonance (MR) and ultrasound imaging are of high interest, but require development to enable quantification of 3D mineralized structures. Emerging image-based methods for quantitative assessment of bone healing may transform clinical research design by displacing binary outcomes classification (union/nonunion) and ultimately enhance clinical care by enabling early nonunion detection.
MR is often the most definitive imaging for assessment of musculoskeletal trauma and infection. Although it is not possible to address all the intricacies of these complex topics in a single article, this review will attempt to provide a useful toolbox of skills by discussing several common clinical scenarios faced by emergency radiologists in interpretation of adult trauma and infection. These scenarios include MR assessment of hip and pelvic fracture, traumatic soft tissue injuries, septic arthritis, soft tissue infection, and osteomyelitis.
Purpose
To demonstrate the effect of teaching a simplified treatment-based classification of proximal femoral fractures on the accuracy, confidence, and inter-reader agreement of radiology residents. The authors hypothesize that these measures will improve after viewing an educational presentation.
Materials and methods
Three radiology residents independently classified 100 operative proximal femoral fractures, both before and after viewing a 45-min educational video describing the simplified classification scheme, with a washout period of at least 12 weeks between sessions. Based on the gold standard established by consensus of two radiologists and an orthopedic trauma surgeon utilizing intraoperative fluoroscopic imaging, operative reports, and pre-procedural imaging, accuracy of classification was calculated for each reader before and after viewing the educational video. Reader confidence was recorded on a 0–10 scale, and inter-reader agreement was calculated with Fleiss’s kappa. McNemar’s test was used to compare accuracy, a paired t test was used to compare confidence, and the Z-test was used to compare kappa values after bootstrapping to determine the standard error of the mean.
Results
The study cohort included 60/100 females, with a mean age of 76.6 years. The pooled classification accuracy was initially 65%, which improved to 80% in the second reading session after viewing the educational video (p < 0.0001). Confidence improved from 6.9 initially to 8.6 (p < 0.0001). Inter-reader agreement improved from a kappa of 0.45 (moderate agreement) to 0.74 (substantial agreement) (p < 0.0001).
Conclusions
A simplified treatment-based classification of proximal femoral fractures is easily taught to radiology residents and resulted in increased accuracy, increased inter-reader agreement, and increased reader confidence.
