Abstract
OBJECTIVE:: Femoral neck fractures that are associated with femoral shaft fractures have historically been associated with high rates of missed diagnosis. Despite the potentially serious consequences of a missed femoral neck fracture, little work has been conducted to rigorously evaluate the ability of commonly used imaging studies to detect such fractures. Our hypothesis was that axial-view computed tomography is superior to plain radiography at detecting femoral neck fractures. DESIGN:: Blinded assessment of a randomized image set that included axial-view computed tomographic scans of the pelvis, anteroposterior-view radiographs of the pelvis, and anteroposterior-view radiographs of the femur. SETTING:: Academic trauma center. PATIENTS:: Twenty-eight patients who had femoral shaft fractures with femoral neck fractures and 60 patients who had femoral shaft fractures without femoral neck fractures. INTERVENTION:: Images that were stripped of demographic data were independently viewed in random order on computer workstations by 5 trauma fellowship-trained orthopaedic surgeons who were blinded to treatment and diagnosis. MAIN OUTCOME MEASUREMENTS:: Sensitivity, specificity, positive post-test probability, and 1 minus negative post-test probability were calculated for diagnosing femoral neck fracture based on each image type. RESULTS:: Interobserver reliability showed "substantial agreement" (kappa > 0.65) for all imaging modalities, indicating that the surgeons had a high level of agreement. All 3 imaging sets had high specificity (>94%) and 1 minus negative post-test probability (>95%) but had poor sensitivity ( 0.2). CONCLUSIONS:: Plain radiography and computed tomography have rates of missed femoral neck fractures that are similar and substantial, with a sensitivity of only 56%-64%. Our data emphasize the importance of intraoperative and postoperative imaging in detecting nondisplaced femoral neck fractures in association with femoral shaft fractures.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 325-330 |
| Number of pages | 6 |
| Journal | Journal of Orthopaedic Trauma |
| Volume | 27 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 2013 |
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Keywords
- computed tomography
- femoral neck fracture
- femoral shaft fracture
- plain radiography
ASJC Scopus subject areas
- Surgery
- Orthopedics and Sports Medicine
Cite this
Diagnosis of femoral neck fracture associated with femoral shaft fracture : Blinded comparison of computed tomography and plain radiography. / Oêtoole, Robert V.; Dancy, Lindsay; Dietz, Adam R.; Pollak, Andrew N.; Johnson, Aaron J.; Osgood, Greg; Nascone, Jason W.; Sciadini, Marcus F.; Castillo, Renan Carlos.
In: Journal of Orthopaedic Trauma, Vol. 27, No. 6, 06.2013, p. 325-330.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Diagnosis of femoral neck fracture associated with femoral shaft fracture
T2 - Blinded comparison of computed tomography and plain radiography
AU - Oêtoole, Robert V.
AU - Dancy, Lindsay
AU - Dietz, Adam R.
AU - Pollak, Andrew N.
AU - Johnson, Aaron J.
AU - Osgood, Greg
AU - Nascone, Jason W.
AU - Sciadini, Marcus F.
AU - Castillo, Renan Carlos
PY - 2013/6
Y1 - 2013/6
N2 - OBJECTIVE:: Femoral neck fractures that are associated with femoral shaft fractures have historically been associated with high rates of missed diagnosis. Despite the potentially serious consequences of a missed femoral neck fracture, little work has been conducted to rigorously evaluate the ability of commonly used imaging studies to detect such fractures. Our hypothesis was that axial-view computed tomography is superior to plain radiography at detecting femoral neck fractures. DESIGN:: Blinded assessment of a randomized image set that included axial-view computed tomographic scans of the pelvis, anteroposterior-view radiographs of the pelvis, and anteroposterior-view radiographs of the femur. SETTING:: Academic trauma center. PATIENTS:: Twenty-eight patients who had femoral shaft fractures with femoral neck fractures and 60 patients who had femoral shaft fractures without femoral neck fractures. INTERVENTION:: Images that were stripped of demographic data were independently viewed in random order on computer workstations by 5 trauma fellowship-trained orthopaedic surgeons who were blinded to treatment and diagnosis. MAIN OUTCOME MEASUREMENTS:: Sensitivity, specificity, positive post-test probability, and 1 minus negative post-test probability were calculated for diagnosing femoral neck fracture based on each image type. RESULTS:: Interobserver reliability showed "substantial agreement" (kappa > 0.65) for all imaging modalities, indicating that the surgeons had a high level of agreement. All 3 imaging sets had high specificity (>94%) and 1 minus negative post-test probability (>95%) but had poor sensitivity ( 0.2). CONCLUSIONS:: Plain radiography and computed tomography have rates of missed femoral neck fractures that are similar and substantial, with a sensitivity of only 56%-64%. Our data emphasize the importance of intraoperative and postoperative imaging in detecting nondisplaced femoral neck fractures in association with femoral shaft fractures.
AB - OBJECTIVE:: Femoral neck fractures that are associated with femoral shaft fractures have historically been associated with high rates of missed diagnosis. Despite the potentially serious consequences of a missed femoral neck fracture, little work has been conducted to rigorously evaluate the ability of commonly used imaging studies to detect such fractures. Our hypothesis was that axial-view computed tomography is superior to plain radiography at detecting femoral neck fractures. DESIGN:: Blinded assessment of a randomized image set that included axial-view computed tomographic scans of the pelvis, anteroposterior-view radiographs of the pelvis, and anteroposterior-view radiographs of the femur. SETTING:: Academic trauma center. PATIENTS:: Twenty-eight patients who had femoral shaft fractures with femoral neck fractures and 60 patients who had femoral shaft fractures without femoral neck fractures. INTERVENTION:: Images that were stripped of demographic data were independently viewed in random order on computer workstations by 5 trauma fellowship-trained orthopaedic surgeons who were blinded to treatment and diagnosis. MAIN OUTCOME MEASUREMENTS:: Sensitivity, specificity, positive post-test probability, and 1 minus negative post-test probability were calculated for diagnosing femoral neck fracture based on each image type. RESULTS:: Interobserver reliability showed "substantial agreement" (kappa > 0.65) for all imaging modalities, indicating that the surgeons had a high level of agreement. All 3 imaging sets had high specificity (>94%) and 1 minus negative post-test probability (>95%) but had poor sensitivity ( 0.2). CONCLUSIONS:: Plain radiography and computed tomography have rates of missed femoral neck fractures that are similar and substantial, with a sensitivity of only 56%-64%. Our data emphasize the importance of intraoperative and postoperative imaging in detecting nondisplaced femoral neck fractures in association with femoral shaft fractures.
KW - computed tomography
KW - femoral neck fracture
KW - femoral shaft fracture
KW - plain radiography
UR - http://www.scopus.com/inward/record.url?scp=84878856840&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84878856840&partnerID=8YFLogxK
U2 - 10.1097/BOT.0b013e318271b6c8
DO - 10.1097/BOT.0b013e318271b6c8
M3 - Article
C2 - 22955334
AN - SCOPUS:84878856840
VL - 27
SP - 325
EP - 330
JO - Journal of Orthopaedic Trauma
JF - Journal of Orthopaedic Trauma
SN - 0890-5339
IS - 6
ER -