Dynamic Stress Fluoroscopy for Evaluation of the Femoral Neck After Intramedullary Nails: Improved Sensitivity for Identifying Occult Fractures. Issue 2 (February 2019)

• Record Type: Journal Article
• Authors: Avilucea, Frank R.; Joyce, David; Mir, Hassan R.
• Is Part Of: Journal of orthopaedic trauma. Volume 33:Issue 2(2019)
• Publication Date: 2019-02
• Subjects: femoral neck fracture -- femoral shaft fracture -- intramedullary nail -- dynamic stress fluoroscopy; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000001343
• Languages: English
• ISSNs: 0890-5339

Abstract

Abstract : Objectives: To report on the use of dynamic stress fluoroscopy (DSF) for detection of occult fractures of the femoral neck associated with femoral shaft fractures. To compare DSF with a fully static imaging protocol in detecting occult femoral neck fractures. Design: Multicenter retrospective cohort study. Setting: Two urban level I trauma centers. Participants/Intervention: A consecutive series of 1273 femoral shaft fractures were included. Inclusion criteria were patients treated with an intramedullary rod (antegrade/retrograde), age ≥18 years, a fine-cut (2 mm) preoperative computed tomography and hip radiographs, intraoperative anteroposterior (AP)/lateral fluoroscopic view of the femoral neck before femoral nailing, and a minimum follow-up of 3 months. Patients were divided into 2 groups based on the technique used to identify the presence of a femoral neck fracture after intramedullary fixation of the femoral shaft: DSF or static intraoperative radiographs. Main Outcome Measures: Sensitivity, specificity, positive predictive value, and negative predictive value. Results: Both the static imaging protocol and DSF had high specificity (100%; 100%), positive predictive value (100%; 100%), and negative predictive value (99.5%; 99.6%). Sensitivity was poor (73.7%) for the static protocol group versus high (92.3%) for the DSF group. Conclusions: Compared with a fully static imaging protocol, DSF is a more sensitive and highly specific technique, enabling intraoperative detection of occult fractures of the femoral neck. Level of Evidence: Diagnostic Level III. See Instructions for Authors for complete description of levels of evidence.