A Case Series of Occult Femoral Neck Fracture, Why Plain Radiograph is not Enough?

Vol 5 | Issue 2 | May-Dec 2019 | |John Butarbutar, Rio Aditya, Prettysia Suvarly, Nyoman Aditya Sindunata

DOI 10.13107/ti.2019.v05i01.085


Author: John Butarbutar[1], Rio Aditya[2], Prettysia Suvarly[2], Nyoman Aditya Sindunata[2]

1 Department of Orthopedic & Traumatology, Siloam Hospitals Lippo Village – Pelita Harapan University, Jl. Siloam No. 6, Lippo Karawaci 1600 Tangerang 15811, Indonesia.
2 Clinical Researcher at Orthopedic & Traumatology Department, Siloam Hospitals Lippo Village – Pelita Harapan University, Jl. Siloam No. 6, Lippo Karawaci 1600 Tangerang 15811, Indonesia..

Address of Correspondence
Dr. John Butarbutar,
Department of Orthopedic & Traumatology, Siloam Hospitals Lippo Village – Pelita
Harapan University, Jl. Siloam No. 6, Lippo Karawaci 1600 Tangerang 15811, Indonesia.
E-mail: johnbutar2@gmail.com


Abstract

Background: About 10% of hip fractures are missed on initial presentation and potentially expose patients to increased morbidity and unnecessary complex surgeries [ 2,3]. CT-scan and MRI in the emergency settings have been proposed to avoid a mis-diagnosis [3,6,7].
Case Series: Three cases (two female and one male patient) patients with hip pain were presented with normal x-ray on initial presentation. Further investigation using CT-scan and MRI revealed femoral neck fractures.
Case 1 : A 77 years-old female presented with right hip pain after a ground-level fall. Plain radiograph was normal and the patient was discharged from emergency. One week later, her hip pain worsened and a follow up x-ray showed a displaced femoral neck fracture. The fracture then treated with bipolar hemiarthroplasty.
Case 2 : An 87 years-old female presented with left hip pain after a fall in the bathroom. She was able to bear weight. Initial hip x-ray appeared normal. Further investigation with a pelvic CT scan revealed a displaced femoral neck fracture.
Case 3 : A 49 years-old male presented with worsening right hip pain since more than a week. The patient was physically active and has no history of trauma or associated hip injury. Initial x-ray showed a normal hip but further imaging study using MRI revealed an undisplaced femoral neck fracture. The patient was treated conservatively as he refused to do surgery.
Conclusion: Traumatic hip pain with negative plain radiograph should be followed by MRI or CT -scan to avoid mis-diagnosis.
Keywords: Occult hip fracture, Missed hip fracture, Femoral Neck Fracture, Elderly patient


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How to Cite this article:  Butarbutar J, Aditya R, Suvarly P, Sindunata N A. A Case Series of Occult Femoral Neck Fracture, Why Plain Radiograph is not Enough? Trauma International May -Dec 2019;5(2):

 



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