Diagnostic strategy for elderly patients with isolated greater trochanter fractures on plain radiographs
Abstract Background Isolated greater trochanter (GT) fractures are relatively rare and few studies have assessed the appropriate diagnostic and therapeutic strategies for these fractures. When initial plain radiographs show an isolated GT fracture, underestimation of occult intertrochanteric extensi...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-07-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | http://link.springer.com/article/10.1186/s12891-018-2193-5 |
| _version_ | 1819152657725521920 |
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| author | Nam Hoon Moon Won Chul Shin Min Uk Do Seung Hun Woo Seung Min Son Kuen Tak Suh |
| author_facet | Nam Hoon Moon Won Chul Shin Min Uk Do Seung Hun Woo Seung Min Son Kuen Tak Suh |
| author_sort | Nam Hoon Moon |
| collection | DOAJ |
| description | Abstract Background Isolated greater trochanter (GT) fractures are relatively rare and few studies have assessed the appropriate diagnostic and therapeutic strategies for these fractures. When initial plain radiographs show an isolated GT fracture, underestimation of occult intertrochanteric extension may result in displacement of a previously non-displaced fracture. This study examined the clinical results and value of different diagnostic strategies in elderly patients with isolated GT fractures on plain radiographs. Methods Between January 2010 and January 2015, 30 patients with initial plain radiographs showing isolated GT fractures were examined using MRI, bone scanning and/or CT for suspected occult intertrochanteric extension. We assessed the sensitivity, specificity, and positive and negative predictive value of each test. In addition, we noted the location of the fracture or soft-tissue injury on MRI in addition to treatment results. Results All 30 patients had osteoporosis and fractures caused by minor trauma. MRI revealed isolated GT fractures in nine patients and occult intertrochanteric fractures in 21 patients. Using the MRI-based diagnosis as a reference, the results showed that plain radiographs, bone scans, and CT scans can be used for supplementary examination but they are not appropriate as confirmatory tests for these fractures. However, in patients with both isolated GT fractures seen on plain radiographs and increased uptake in only the GT area on bone scans, MRI revealed isolated GT fractures. The fractures were treated surgically in 20 patients and conservatively in 10 patients with satisfactory clinical results. Conclusions We confirmed that MRI-based examination is useful in all symptomatic elderly patients whose plain radiographic findings reveal isolated GT fractures. However, we suggest that there is a need to establish a diagnostic strategy through increased understanding of the available diagnostic methods. We believe that surgical treatment should be considered in patients with occult intertrochanteric fractures that are detected on MRI. |
| first_indexed | 2024-12-22T14:52:47Z |
| format | Article |
| id | doaj.art-ede4fe575222497e93b0f25f3519689d |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-22T14:52:47Z |
| publishDate | 2018-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-ede4fe575222497e93b0f25f3519689d2022-12-21T18:22:17ZengBMCBMC Musculoskeletal Disorders1471-24742018-07-011911910.1186/s12891-018-2193-5Diagnostic strategy for elderly patients with isolated greater trochanter fractures on plain radiographsNam Hoon Moon0Won Chul Shin1Min Uk Do2Seung Hun Woo3Seung Min Son4Kuen Tak Suh5Department of Orthopedic Surgery, Pusan National University Hospital, Pusan National University School of MedicineDepartment of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of MedicineDepartment of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of MedicineDepartment of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of MedicineDepartment of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of MedicineDepartment of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of MedicineAbstract Background Isolated greater trochanter (GT) fractures are relatively rare and few studies have assessed the appropriate diagnostic and therapeutic strategies for these fractures. When initial plain radiographs show an isolated GT fracture, underestimation of occult intertrochanteric extension may result in displacement of a previously non-displaced fracture. This study examined the clinical results and value of different diagnostic strategies in elderly patients with isolated GT fractures on plain radiographs. Methods Between January 2010 and January 2015, 30 patients with initial plain radiographs showing isolated GT fractures were examined using MRI, bone scanning and/or CT for suspected occult intertrochanteric extension. We assessed the sensitivity, specificity, and positive and negative predictive value of each test. In addition, we noted the location of the fracture or soft-tissue injury on MRI in addition to treatment results. Results All 30 patients had osteoporosis and fractures caused by minor trauma. MRI revealed isolated GT fractures in nine patients and occult intertrochanteric fractures in 21 patients. Using the MRI-based diagnosis as a reference, the results showed that plain radiographs, bone scans, and CT scans can be used for supplementary examination but they are not appropriate as confirmatory tests for these fractures. However, in patients with both isolated GT fractures seen on plain radiographs and increased uptake in only the GT area on bone scans, MRI revealed isolated GT fractures. The fractures were treated surgically in 20 patients and conservatively in 10 patients with satisfactory clinical results. Conclusions We confirmed that MRI-based examination is useful in all symptomatic elderly patients whose plain radiographic findings reveal isolated GT fractures. However, we suggest that there is a need to establish a diagnostic strategy through increased understanding of the available diagnostic methods. We believe that surgical treatment should be considered in patients with occult intertrochanteric fractures that are detected on MRI.http://link.springer.com/article/10.1186/s12891-018-2193-5Greater trochanter fractureOccult intertrochanteric fractureDiagnosisRadiographs |
| spellingShingle | Nam Hoon Moon Won Chul Shin Min Uk Do Seung Hun Woo Seung Min Son Kuen Tak Suh Diagnostic strategy for elderly patients with isolated greater trochanter fractures on plain radiographs BMC Musculoskeletal Disorders Greater trochanter fracture Occult intertrochanteric fracture Diagnosis Radiographs |
| title | Diagnostic strategy for elderly patients with isolated greater trochanter fractures on plain radiographs |
| title_full | Diagnostic strategy for elderly patients with isolated greater trochanter fractures on plain radiographs |
| title_fullStr | Diagnostic strategy for elderly patients with isolated greater trochanter fractures on plain radiographs |
| title_full_unstemmed | Diagnostic strategy for elderly patients with isolated greater trochanter fractures on plain radiographs |
| title_short | Diagnostic strategy for elderly patients with isolated greater trochanter fractures on plain radiographs |
| title_sort | diagnostic strategy for elderly patients with isolated greater trochanter fractures on plain radiographs |
| topic | Greater trochanter fracture Occult intertrochanteric fracture Diagnosis Radiographs |
| url | http://link.springer.com/article/10.1186/s12891-018-2193-5 |
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