In this section we are going to talk about femoral neck fractures. We get a lot of elderly patients who come in through the ER with history of trauma, usually from a fall. As these patients are older, they have a lot of degenerative joint disease and are osteopenic or osteoporotic. Both of these factors can make it more difficult to detect subtle femoral neck fractures. As these fractures are clinically very significant, you want to make sure that you recognize subtle fractures, so that appropriate medical care is not delayed.
So here is a case of a subtle femoral neck fracture. Your index of suspicion has to be very high on a case like this. Even a tiny irregularity or atypical calcification of the femoral neck can be a sign of a fracture. So when I see this calcification, I will not pass it up for degenerative joint disease and degenerative calcification/osteophytes which usually occur along the femoral head or acetabular region.
Small calcification along the lateral femoral neck depicted by the arrow. This was the only abnormality detected on the X rays.
This was the only visible abnormality, but it should raise enough suspicion to order additional imaging. At this point, a CT scan is the most appropriate test to detect the fracture. MRI is even more sensitive for detecting femoral neck fractures, but CT scan is easier and more available in the ER setting.
So here are some pics from the CT scan. Please refer to the video for see all the fracture lines that were detected.
Arrow clearly depicts fracture that was originally seen as a calcification by the X-ray.
Additional fracture site medially not seen on the X-Ray. Please refer to the corresponding femoral neck fracture video to scroll through the CT scan and see all the fracture lines.
One last important lesson. There are even some occult femoral neck fractures that may not even be detected on CT scan and can only be seen on MRI. This is rare. It is up to clinician and the radiologist to have good communication that if an occult fracture is strongly suspected and both X ray and CT are negative, MRI should be performed as a final problem-solving tool. In my experience, over %95 percent of femoral neck fractures are easily seen on the CT scan so the need to do MRI is rare but very valuable.
Posted on behalf of Advanced Healing Institute
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