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Classification and diagnosis of intra-capsular fractures of the proximal femur. Hip fracture presenting as isolated knee pain. In: Callaghan JJ, Rosenberg AG, Rubash HE, eds. Edinburgh: Churchill Livingstone, 1994:260–72.īrown CR Jr. Magnetic resonance imaging of the femoral head after acute intracapsular fracture of the femoral neck. Speer KP, Spritzer CE, Harrelson JM, Nunley JA. Magnetic resonance imaging compared with bone-scanning. Diagnosis of occult fractures about the hip. Prospective evaluation of patients with suspected hip fracture and indeterminate radiographs: use of T 1-weighted MR images. An assessment of perfusion of the head by dynamic MRI. Konishiike T, Makihata E, Tago H, Sato T, Inoue H. Contrast enhanced magnetic resonance imaging for femoral neck fracture. Kamano M, Narita S, Honda Y, Fukushima K, Yamano Y. Magnetic resonance imaging of occult fractures of the proximal femur. Haramati N, Staron RB, Barax C, Feldman F. The use of MRI in the diagnosis of occult hip fractures in the elderly: a preliminary review. Comparison of MRI with bone scanning for suspected hip fracture in elderly patients. New York: Saunders, 2001:534–43.Įvans PD, Wilson C, Lyons K. Ruddy S, Harris ED, Sledge CB, Kelley WN, eds. Pitfalls of bone scintigraphy in suspected hip fractures. Lewis SL, Rees JI, Thomas GV, Williams LA. Radionuclide bone imaging in the early detection of fractures of the proximal femur (hip): multifactorial analysis. Holder LE, Schwarz C, Wernicke PG, Michael RH. Early detection of stress fractures using 99mTc-polyphosphate. Geslien GE, Thrall JH, Espinosa JL, Older RA. A prospective study on socioeconomic aspects of fracture of the proximal femur. Schurch MA, Rizzoli R, Mermillod B, Vasey H, Michel JP, Bonjour JP. Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis. Genant HK, Cooper C, Poor G, Reid I, Ehrlich G, Kanis J, et al. Osteoporosis: etiology, diagnosis, and management. Washington, D.C.: Office of Technology Assessment, U.S. Hip fracture outcomes in people age fifty and over. The economic impact of geriatric hip fractures. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. The socioeconomic burden of fractures: today and in the 21st century. When hip fracture is detected early, appropriate treatment can minimize morbidity and mortality and prevent the rapid decline in quality of life that often is associated with this injury.
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A heightened suspicion for hip fracture should lead to further diagnostic evaluation, especially if the patient has additional risk factors, such as use of a complicated drug regimen, impaired vision, physical or neurologic impairment, or comorbid condition (e.g., osteoporosis, malignancy). Even when a patient is able to walk and has no documented trauma, localized hip pain, or typical shortening and malrotation deformity, the family physician should be alert to the possibility of hip fracture, particularly in a patient who is older than 65 years, presents with nonspecific leg discomfort, and complains of difficulty bearing weight on the affected limb. A high index of suspicion often is required for prompt diagnosis and treatment of an occult hip fracture. In these patients, additional studies, such as magnetic resonance imaging or bone scanning, may be necessary to confirm the presence of hip fracture. Their ability to walk may be unaffected, and initial radiographic findings may be indeterminate. In some instances, however, patients with hip fracture may complain only of vague pain in their buttocks, knees, thighs, groin, or back. They are often unable to walk, and they may exhibit shortening and external rotation of the affected limb. Patients with hip fracture typically present to the emergency department or their physician's office after a fall.