Difference between revisions of "X-ray of hip fractures"

From radlines.org
Jump to navigation Jump to search
(Started)
 
m (→‎Further imaging: enlarged)
 
(13 intermediate revisions by the same user not shown)
Line 1: Line 1:
−
{{Authors
+
{{Top
 
|author1=[[User:Mikael Häggström|Mikael Häggström]]
 
|author1=[[User:Mikael Häggström|Mikael Häggström]]
 
|author2=
 
|author2=
 
}}
 
}}
−
'''Hip fractures''' are fractures of the proximal femur, and are classified as follows:
+
 
 +
'''Hip fractures''' are [[fractures]] of the [[proximal femur]].
 +
 
 +
==Detection==
 +
[[File:X-ray of mildly compressed hip fracture, annotated.jpg|thumb|[[Projectional radiography|X-ray]] shows a suspected mildly compressed hip fracture, as incongruity of the cortex.]]
 +
 
 +
{{Fracture detection on X-ray}}
 +
 
 +
Also have a glance at the projected [[pelvic bones]].
 +
 
 +
===Further imaging===
 +
If findings are equivocal of a fracture, or there is a strong clinical suspicion despite a normal X-ray, further imaging can be done with CT and/or MRI:
 +
 
 +
;Case 1:
 +
Continued from X-ray above:
 +
<gallery mode=packed heights=170>
 +
File:CT of mildly compressed hip fracture, annotated.png|[[CT scan]] confirms the diagnosis, in this case as a radiolucent line.
 +
File:X-ray of Hansson pins for mildly compressed hip fracture.jpg|The patient was treated with Hansson pins.
 +
</gallery>
 +
 
 +
{{Further|X-ray of the hip#Prostheses and other orthopedic fixations}}
 +
 
 +
;Case 2:
 +
<gallery mode=packed heights=170>
 +
File:X-ray of subtle compressive hip fracture.jpg|thumb|In this case, a hip fracture appearing as a subtle subcapital radiodense line.
 +
File:CT of subtle compressive hip fracture.jpg|Subsequent [[CT scan]] of the same case as above. The cortex is coherent, which is atypical of a fracture.
 +
File:T1 TSE MRI of hip fracture.jpg|Subsequent T1-weighted turbo spin echo [[MRI]] confirms a fracture, as the surrounding bone marrow has low signal from edema.
 +
</gallery>
 +
 
 +
==Classification==
 
[[File:Hip fracture classification.png|400px|center]]
 
[[File:Hip fracture classification.png|400px|center]]
  
−
==Subcapital==
+
===Subcapital===
 
In AO classification, these fractures are classified as either nondisplaced or displaced (not necessarily including how much).<ref>{{cite web|url=https://www2.aofoundation.org/wps/portal/surgery?showPage=diagnosis&bone=Femur&segment=Proximal|title=Revised AO/OTA classification (Jan 2018) - Proximal femur|accessdate=2018-06-19}}</ref>
 
In AO classification, these fractures are classified as either nondisplaced or displaced (not necessarily including how much).<ref>{{cite web|url=https://www2.aofoundation.org/wps/portal/surgery?showPage=diagnosis&bone=Femur&segment=Proximal|title=Revised AO/OTA classification (Jan 2018) - Proximal femur|accessdate=2018-06-19}}</ref>
  
−
==Trochanteric==
+
===Trochanteric===
 
Trochanteric fractures are subdivided into either intertrochanteric (between the [[greater trochanter|greater]] and [[lesser trochanter]]<ref name=Dandy2009/>) or pertrochanteric (through the trochanters<ref name=Dandy2009>[https://books.google.com/books?id=zxiHcX7QgsgC&pg=PA245 Page 245] {{webarchive|url=https://web.archive.org/web/20171105193617/https://books.google.com/books?id=zxiHcX7QgsgC&pg=PA245 |date=5 November 2017 }} in: {{cite book|title=Essential Orthopaedics and Trauma, 5th edition|author=David J. Dandy, Dennis J. Edwards|publisher=Elsevier Health Sciences|year=2009|isbn=9780702042096}}</ref><ref name="SchipperSteyerberg2009">{{cite journal|last1=Schipper|first1=Inger B.|last2=Steyerberg|first2=Ewout W.|last3=Castelein|first3=Rene M.|last4=Vugt|first4=Arie B. van|title=Reliability of the AO/ASIF classification for pertrochanteric femoral fractures|journal=Acta Orthopaedica Scandinavica|volume=72|issue=1|year=2009|pages=36–41|doi=10.1080/000164701753606662}}</ref>) by the [[Müller AO Classification of fractures]].<ref>{{cite web|url=https://www2.aofoundation.org/wps/portal/surgery?showPage=diagnosis&bone=Femur&segment=Proximal|title=Proximal femur|website=[[AO Foundation]]|author=Ernst Raaymakers, Inger Schipper, Rogier Simmermacher, Chris van der Werken|accessdate=2017-04-23|deadurl=no|archiveurl=https://web.archive.org/web/20170424174524/https://www2.aofoundation.org/wps/portal/surgery?showPage=diagnosis&bone=Femur&segment=Proximal|archivedate=24 April 2017|df=dmy-all}}</ref> Practically, the difference between these types is minor. The terms are often used synonymously.<ref>[https://books.google.com/books?id=n069BAAAQBAJ&pg=PA190 Page 190] {{webarchive|url=https://web.archive.org/web/20171105193617/https://books.google.com/books?id=n069BAAAQBAJ&pg=PA190 |date=5 November 2017 }} in: {{cite book|title=Global Orthopedics: Caring for Musculoskeletal Conditions and Injuries in Austere Settings|author=Richard A. Gosselin, David A. Spiegel, Michelle Foltz|publisher=Springer Science & Business|year=2014|isbn=9781461415787}}</ref><ref>[https://books.google.com/books?id=DXjl7VPr9T8C&pg=PA365 Page 365] {{webarchive|url=https://web.archive.org/web/20171105193617/https://books.google.com/books?id=DXjl7VPr9T8C&pg=PA365 |date=5 November 2017 }} in: {{cite book|title=Non-Invasive Respiratory Support, Third edition: A Practical Handbook|author=Anita K. Simonds|publisher=CRC Press|year=2007|isbn=9780340809846}}</ref> An ''isolated trochanteric fracture'' involves one of the trochanters without going through the anatomical axis of the femur, and may occur in young individuals due to forceful muscle contraction.<ref name=Pope2014>[https://books.google.com/books?id=OAuqBAAAQBAJ&pg=PA303 Page 303] {{webarchive|url=https://web.archive.org/web/20171105193617/https://books.google.com/books?id=OAuqBAAAQBAJ&pg=PA303 |date=5 November 2017 }} in: {{cite book|title=Musculoskeletal Imaging E-Book|author=Thomas Pope, Hans L. Bloem, Javier Beltran, William B. Morrison, David John Wilson|edition=2|publisher=Elsevier Health Sciences|year=2014|isbn=9780323278188}}</ref> Yet, an ''isolated trochanteric fracture'' may not be regarded as a true hip fracture because it is not cross-sectional.
 
Trochanteric fractures are subdivided into either intertrochanteric (between the [[greater trochanter|greater]] and [[lesser trochanter]]<ref name=Dandy2009/>) or pertrochanteric (through the trochanters<ref name=Dandy2009>[https://books.google.com/books?id=zxiHcX7QgsgC&pg=PA245 Page 245] {{webarchive|url=https://web.archive.org/web/20171105193617/https://books.google.com/books?id=zxiHcX7QgsgC&pg=PA245 |date=5 November 2017 }} in: {{cite book|title=Essential Orthopaedics and Trauma, 5th edition|author=David J. Dandy, Dennis J. Edwards|publisher=Elsevier Health Sciences|year=2009|isbn=9780702042096}}</ref><ref name="SchipperSteyerberg2009">{{cite journal|last1=Schipper|first1=Inger B.|last2=Steyerberg|first2=Ewout W.|last3=Castelein|first3=Rene M.|last4=Vugt|first4=Arie B. van|title=Reliability of the AO/ASIF classification for pertrochanteric femoral fractures|journal=Acta Orthopaedica Scandinavica|volume=72|issue=1|year=2009|pages=36–41|doi=10.1080/000164701753606662}}</ref>) by the [[Müller AO Classification of fractures]].<ref>{{cite web|url=https://www2.aofoundation.org/wps/portal/surgery?showPage=diagnosis&bone=Femur&segment=Proximal|title=Proximal femur|website=[[AO Foundation]]|author=Ernst Raaymakers, Inger Schipper, Rogier Simmermacher, Chris van der Werken|accessdate=2017-04-23|deadurl=no|archiveurl=https://web.archive.org/web/20170424174524/https://www2.aofoundation.org/wps/portal/surgery?showPage=diagnosis&bone=Femur&segment=Proximal|archivedate=24 April 2017|df=dmy-all}}</ref> Practically, the difference between these types is minor. The terms are often used synonymously.<ref>[https://books.google.com/books?id=n069BAAAQBAJ&pg=PA190 Page 190] {{webarchive|url=https://web.archive.org/web/20171105193617/https://books.google.com/books?id=n069BAAAQBAJ&pg=PA190 |date=5 November 2017 }} in: {{cite book|title=Global Orthopedics: Caring for Musculoskeletal Conditions and Injuries in Austere Settings|author=Richard A. Gosselin, David A. Spiegel, Michelle Foltz|publisher=Springer Science & Business|year=2014|isbn=9781461415787}}</ref><ref>[https://books.google.com/books?id=DXjl7VPr9T8C&pg=PA365 Page 365] {{webarchive|url=https://web.archive.org/web/20171105193617/https://books.google.com/books?id=DXjl7VPr9T8C&pg=PA365 |date=5 November 2017 }} in: {{cite book|title=Non-Invasive Respiratory Support, Third edition: A Practical Handbook|author=Anita K. Simonds|publisher=CRC Press|year=2007|isbn=9780340809846}}</ref> An ''isolated trochanteric fracture'' involves one of the trochanters without going through the anatomical axis of the femur, and may occur in young individuals due to forceful muscle contraction.<ref name=Pope2014>[https://books.google.com/books?id=OAuqBAAAQBAJ&pg=PA303 Page 303] {{webarchive|url=https://web.archive.org/web/20171105193617/https://books.google.com/books?id=OAuqBAAAQBAJ&pg=PA303 |date=5 November 2017 }} in: {{cite book|title=Musculoskeletal Imaging E-Book|author=Thomas Pope, Hans L. Bloem, Javier Beltran, William B. Morrison, David John Wilson|edition=2|publisher=Elsevier Health Sciences|year=2014|isbn=9780323278188}}</ref> Yet, an ''isolated trochanteric fracture'' may not be regarded as a true hip fracture because it is not cross-sectional.
  
−
==References==
+
===Misalignment===
−
{{reflist}}
+
{{Fracture misalignment|align=center}}
 +
 
 +
==Reporting==
 +
{{Fracture reporting}}
 +
 
 +
{{Bottom}}
  
 
==External links==
 
==External links==
 
*[https://www2.aofoundation.org/wps/portal/surgery?showPage=diagnosis&bone=Femur&segment=Proximal AO classification of proximal femur fractures]
 
*[https://www2.aofoundation.org/wps/portal/surgery?showPage=diagnosis&bone=Femur&segment=Proximal AO classification of proximal femur fractures]

Latest revision as of 16:21, 29 January 2019

Author: Mikael Häggström [notes 1]

Hip fractures are fractures of the proximal femur.

Detection

X-ray shows a suspected mildly compressed hip fracture, as incongruity of the cortex.

edit
Even if there's an initial obvious fracture, evaluate:

  • Bone contours for disruptions
  • Bone areas for unusual lines that are either hypoattenuating (in case of separation) or hyperattenuating (in case of compression)

Also have a glance at the projected pelvic bones.

Further imaging

If findings are equivocal of a fracture, or there is a strong clinical suspicion despite a normal X-ray, further imaging can be done with CT and/or MRI:

Case 1

Continued from X-ray above:

  • CT scan confirms the diagnosis, in this case as a radiolucent line.

  • The patient was treated with Hansson pins.

Further information: X-ray of the hip#Prostheses and other orthopedic fixations
Case 2

  • In this case, a hip fracture appearing as a subtle subcapital radiodense line.

  • Subsequent CT scan of the same case as above. The cortex is coherent, which is atypical of a fracture.

  • Subsequent T1-weighted turbo spin echo MRI confirms a fracture, as the surrounding bone marrow has low signal from edema.

Classification

Hip fracture classification.png

Subcapital

In AO classification, these fractures are classified as either nondisplaced or displaced (not necessarily including how much).[1]

Trochanteric

Trochanteric fractures are subdivided into either intertrochanteric (between the greater and lesser trochanter[2]) or pertrochanteric (through the trochanters[2][3]) by the Müller AO Classification of fractures.[4] Practically, the difference between these types is minor. The terms are often used synonymously.[5][6] An isolated trochanteric fracture involves one of the trochanters without going through the anatomical axis of the femur, and may occur in young individuals due to forceful muscle contraction.[7] Yet, an isolated trochanteric fracture may not be regarded as a true hip fracture because it is not cross-sectional.

Misalignment

Types of fracture misalignment:[8]
  • Displacement
  • Angulation
  • Distraction (making bone longer)
  • Impaction or shortening
  • Rotation


Reporting

General notes on fracture reporting

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.

References

  1. ↑ . Revised AO/OTA classification (Jan 2018) - Proximal femur. Retrieved on 2018-06-19.
  2. ↑ 2.0 2.1 Page 245 in: David J. Dandy, Dennis J. Edwards (2009). Essential Orthopaedics and Trauma, 5th edition . Elsevier Health Sciences. ISBN 9780702042096. 
  3. ↑ Schipper, Inger B.; Steyerberg, Ewout W.; Castelein, Rene M.; Vugt, Arie B. van (2009). "Reliability of the AO/ASIF classification for pertrochanteric femoral fractures ". Acta Orthopaedica Scandinavica 72 (1): 36–41. doi:10.1080/000164701753606662. 
  4. ↑ Ernst Raaymakers, Inger Schipper, Rogier Simmermacher, Chris van der Werken. Proximal femur. AO Foundation. Archived from the original on 24 April 2017. Retrieved on 2017-04-23.
  5. ↑ Page 190 in: Richard A. Gosselin, David A. Spiegel, Michelle Foltz (2014). Global Orthopedics: Caring for Musculoskeletal Conditions and Injuries in Austere Settings . Springer Science & Business. ISBN 9781461415787. 
  6. ↑ Page 365 in: Anita K. Simonds (2007). Non-Invasive Respiratory Support, Third edition: A Practical Handbook . CRC Press. ISBN 9780340809846. 
  7. ↑ Page 303 in: Thomas Pope, Hans L. Bloem, Javier Beltran, William B. Morrison, David John Wilson (2014). Musculoskeletal Imaging E-Book (2 ed.). Elsevier Health Sciences. ISBN 9780323278188. 
  8. ↑ . Introduction to Trauma X-ray. Radiology Masterclass. Retrieved on 2018-07-03.

External links

Retrieved from "https://radlines.org/index.php?title=X-ray_of_hip_fractures&oldid=2954"