Initial clinical experience of the use of digital tomosynthesis in the assessment of suspected fracture neck of femur in the elderly

Abstract

Objective: This study was undertaken to evaluate the use of digital tomosynthesis (tomogram) for diagnosis of suspected fracture neck of femur (NOF). We hypothesised that the use of cross-sectional imaging (MRI/CT) could be reduced by using tomogram to separate the patients with suspected NOF fractures that require MRI/CT scan from those who do not.

Materials and method: Forty-one patients with a clinically suspected NOF fracture, following trauma, with negative AP and lateral hip X-rays, underwent a hip tomogram examination. Patients with a negative tomogram and clinically moderate to high probability of a hip fracture underwent MRI/CT within 48 h.

Result: Tomogram identified fracture NOF in six patients, who underwent appropriate surgical treatment without needing further imaging. Fifteen patients, with negative tomogram examinations for fracture NOF and a low clinical probability of a fracture did not undergo additional MRI/CT scanning. At 6 months of follow-up, none of the patients returned to the hospital with complications. Twenty patients with moderate to high clinical probability of fracture NOF with negative or inconclusive tomogram underwent additional MRI/CT scanning (19 MRI, 1 CT). Two patients showed fracture NOF, and one patient with greater trochanter fracture on tomogram showed fracture NOF on MRI scan. Seventeen patients showed soft tissue injury, bone oedema or pubic rami/acetabular fractures on MRI scan.

Conclusion: Tomogram is a reliable imaging modality that can be used to select the patients who will need additional MRI/CT scan following negative or equivocal plain X-ray in patients with suspected hip fractures following fall.

Level of evidence: III.