Diagnosis of femoral neck fracture associated with femoral shaft fracture: Blinded comparison of computed tomography and plain radiography

Robert V. Oêtoole, Lindsay Dancy, Adam R. Dietz, Andrew N. Pollak, Aaron J. Johnson, Greg Osgood, Jason W. Nascone, Marcus F. Sciadini, Renan Carlos Castillo

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)325-330
Number of pages6
JournalJournal of Orthopaedic Trauma
Volume27
Issue number6
DOIs
StatePublished - Jun 2013

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Femoral Neck Fractures
Femoral Fractures
Radiography
Tomography
Pelvis
Trauma Centers
Femur
Demography
Sensitivity and Specificity
Wounds and Injuries

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 journalArticle

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. / Diagnosis of femoral neck fracture associated with femoral shaft fracture : Blinded comparison of computed tomography and plain radiography. In: Journal of Orthopaedic Trauma. 2013 ; Vol. 27, No. 6. pp. 325-330.
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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

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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

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