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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 10, 1344-1346.
doi: 10.1302/0301-620X.89B10.19539  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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Are occult fractures of the hip and pelvic ring mutually exclusive?

P. Lakshmanan, MS(Orth), AFRCS, Specialist Registrar in Trauma and Orthopaedics1; A. Sharma, MS(Orth), MCh(Orth), Locum Consultant Surgeon in Trauma and Orthopaedics2; K. Lyons, FRCR, Consultant Radiologist2; and J. P. Peehal, MS(Orth), MRCS, Trust Registrar in Trauma and Orthopaedics3

1 Newcastle General Hospital, Westgate Road, Newcastle-upon-Tyne NE4 6BE, UK.
2 University Hospital of Wales Heath Park, Cardiff CF14 4XW, UK.
3 New Cross Hospital, Wednesfield Road, Wolverhampton WV10 0QP, UK.

Correspondence should be sent to Mr P. Lakshmanan at 36 Greenhills, Killingworth, Newcastle-Upon-Tyne NE12 5BB, UK; e-mail: lakunns{at}gmail.com

We have evaluated retrospectively the relationship of bony injuries seen on 106 consecutive MR scans in elderly patients of a mean age of 81.4 years (67 to 101) who were unable to bear weight after a low-energy injury.

There were no visible fractures on plain radiographs of the hip but eight patients (7.5%) had fractures of the pubic ramus. In 43 patients (40.5%) MRI revealed a fracture of the femoral neck and in 26 (24.5%) there was a fracture of a pubic ramus. In 17 patients (16%) MRI showed an occult sacral fracture and all of these had a fracture of the pubic ramus. No patient with a fracture of the femoral neck had an associated fracture of the pelvic ring or vice versa. Occult fracture of the hip and of the pelvic ring appear to be mutually exclusive and if an acute fracture of the pubic ramus is diagnosed radiologically further investigations are not needed to rule out an occult fracture of the hip.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General