Learning objectives
Our purpose is to review the imaging manifestations of subtle and misleading fractures of the proximal femur,
including (1) osteochondral fractures of the femoral head; (2) subchondral fractures of the femoral head; (3) stress or occult fractures of the femoral neck; (4) minimally impacted subcapital fractures; (5) non-displaced intertrochanteric fractures; (6) non-displaced trochanteric avulsion fractures; and (7) pathologic fractures.
In our presentation we also cover the various technical and clinical factors that may complicate prompt radiologic recognition of such injuries.
In order to achieve this...
Background
The radiographic diagnosis of fractures of the proximal femur is usually straightforward.
However,
the suboptimal quality of some emergency plain films may represent a significant challenge for the radiologist on call.
A thorough knowledge of normal anatomy,
anatomic variations and non-anatomical pitfalls is required for interpreting these radiographs.
In spite of specific training,
fractures with subtle or misleading radiographic presentation may still cause diagnostic dilemmas.
More importantly,
they may be missed unless advanced crossectional imaging is performed.
In our clinical practice,
we have found 64-slice...
Imaging findings OR Procedure details
Anatomy of the hip
Anterior and posterior acetabular rims
On AP views,
the anterior and posterior acetabular rims (figure 1A) project on the femoral head.
In a particularly anteverted acetabulum,
the anterior rim projects on the upper aspect of the femoral head,
which may mimic subcondral fracture or avascular necrosis (figure 1B).
In coxa profunda (figure 1C) or hip osteoarthritis,
the posterior acetabular rim may project on the head-neck junction line,
which should not be misinterpreted as an impacted subcapital fracture.
Acetabular notch
The acetabular...
Conclusion
Fractures of the proximal femur may present with subtle or misleading radiographic findings.
In the emergency setting familiarity with normal anatomy and key diagnostic findings may help identify or rule out these injuries.
However prompt evaluation with crossectional imaging will be required in many instances.
Personal Information
J.
Salceda Artola,
J.M.
Mellado,
R.
Bermejo,
N.
Yanguas,
S.
Solanas,
J.
Martín Cuartero,
S.
Solchaga,
R.M.
Cozcolluela.
Sección de Radiología,
Hospital Reina Sofía de Tudela,
Carretera de Tarazona km.
3,
31500,
Tudela (Navarra),
Spain.
Mail to:
[email protected]
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Subchondral...