# Digital X-ray Tomography in the Clinical Diagnosis of Suspected Neck of Femur Fractures

## TL;DR

Digital X-ray tomography helps diagnose hidden femur neck fractures not visible on regular X-rays, offering a cost-effective alternative to MRI/CT.

## Contribution

Digital tomography is presented as a novel, cost-effective diagnostic tool for occult femur neck fractures in resource-limited settings.

## Key findings

- Digital tomography identified 43 fractures in 100 patients with suspected but undetected femur neck fractures.
- Tomography was accurate enough to avoid unnecessary MRI/CT scans in 37 patients with low clinical suspicion.
- Follow-up showed no complications in patients with negative tomography results after 12 months.

## Abstract

Background

Occult fracture of the neck of femur (NOF) is a challenging acute presentation for orthopaedic surgeons. This study aimed to evaluate the use of digital tomography in the diagnosis of occult NOF fractures not visible on plain radiographs.

Materials and methods

A total of 100 patients admitted with suspected NOF fractures but negative plain X-rays underwent digital tomography studies. In equivocal tomography studies, patients who are clinically moderate to high probability suspicious of a hip fracture underwent further MRI or CT scans.

Result

In this study, 100 patients with suspected NOF fractures underwent a digital tomography investigation. The tomography identified 43 patients with fractures, including 18 with NOF, and therefore, they were surgically treated. In addition, 14 additional patients had other pelvic fractures and were treated conservatively. Eleven patients with suspicious fractures identified on tomography underwent MRI/CT to delineate the fracture pattern. From this subgroup, two patients were found to have fracture extension to NOF. Moreover, eight patients underwent tomography but were inconclusive and underwent MRI/CT, which identified five NOF fractures. A total of 37 patients with a negative tomogram for fracture NOF and a low clinical probability of a fracture did not undergo additional MRI/CT scanning. At 12 months of follow-up, this group had no readmissions due to complications related to their initial injury.

Conclusion

Tomography is a novel imaging modality that can be used to diagnose NOF and other pelvic fractures. This is a promising imaging modality, especially in patients not suitable to undergo MRI/CT. It offers a cost-effective and accurate alternative, making it an effective tool for managing patients in economically disadvantaged regions, as it is relatively easier to interpret.