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© 2009 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 28:1447-1452 • 0278-4297

Posttraumatic Painful Hip

Sonography as a Screening Test for Occult Hip Fractures

Ori Safran, MD, Vladimir Goldman, MD, Yaakov Applbaum, MD, Charles Milgrom, MD, Ronald Bloom, MD, Amos Peyser, MD and David Kisselgoff, MD

Departments of Orthopedics (O.S., V.G., C.M., A.P.) and Radiology (Y.A., R.B., D.K.), Hadassah Hebrew University Medical Center, Jerusalem, Israel.

Address correspondence to Ori Safran, MD, Department of Orthopedics, Hadassah Hebrew University Medical Center, Kyriat Hadassah, 91120 Jerusalem, Israel., E-mail: oris{at}hadassah.org.il

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.

Key Words: fracture • hip • magnetic resonance imaging • occult • sonography

Abbreviations: MRI, magnetic resonance imaging • STIR, short tau inversion recovery

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