The Consequence of Delayed Diagnosis of an Occult Hip Fracture

Je, Sangbong; Kim, Hyejin; Ryu, Seokyong; Cho, Sukjin; Oh, Sungchan; Kang, Taekyung; Choi, Seungwoon

Abstract

PURPOSE
Occult hip fracture is not evident on radiographs and the diagnosis is often missed or delayed. This study was undertaken in order to identify the clinical characteristics and complications of patients with a delayed diagnosis of an occult hip fracture.
METHODS
We retrospectively reviewed patients with occult hip fracture who had normal findings on initial radiographs, the diagnosis was made on additional studies between August 2006 and February 2012. Patients who were diagnosed as having occult hip fractures at the first visit were categorized as non-delayed group and those who were not diagnosed at the first visit were categorized as delayed group.
RESULTS
Non-delayed group included 43 patients (86%). In the remaining 7 patients (delayed group), the diagnosis was delayed by a mean of 9.6 days (range 3~19 days). Patients who were diagnosed with an occult fracture on the initial visit presented later than those with a delayed diagnosis (41/43 .vs. 3/7, p=0.002). Other clinical features were no difference between the two groups. Patients in the delayed diagnosis group were more likely to have fracture displacement (4/7 .vs. 0/43)15patients in non-delayed group (34.9%) needed operative treatment, whereas all delayed patients (100%) needed operative treatment.
CONCLUSION
A delayed diagnosis of occult hip fractures was associated with increased rate of displacement and operation. In patients suspected of having occult hip fractures, additional studies should be recommended.