Журнал остеопороза и физической активности
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Conventional A.P.-Radiographs are not reliable in Detecting Acetabular and Proximal Femur Fractures in the Elderly

Andreas Schicho, Philipp Birk, Kevin Seeber, Peter H. Richter and Florian Gebhard

Blunt pelvic traumata are common injuries especially among elderly patients. It is well known, that standard x-ray diagnostics fail to detect all fractures. We set up a retrospective study to gain profound knowledge of the actual informative value of a single, plain a.p. pelvic radiograph in these injuries for detecting acetabular and proximal femoral fractures as a standardized starting point in the radiologic work-up. We analysed the radiological reports, all validated by a board certified radiologist, for patients aged 75 years and older who had a blunt pelvic trauma and had both a standard a.p. pelvic x-ray and pelvic CT scan in the emergency department over a 3-year period. In 233 patients aged 75 years and older, we found 35 acetabular fractures. The calculated specificity of the plain x-ray was high (97.3%), but sensitivity was rather low (66.6%). The positive and negative predictive value were 85.7% and 92.4%, respectively. The number of proximal femur fractures found in CT was comparable (n = 46; prevalence 19.8%). The calculated sensitivity was 82.6%, specificity 93.0%, positive predictive and negative predictive values were 74.5% and 95.6%.

We thus recommend a CT scan of the pelvis whenever in doubt of the reliability of the a.p. x-ray, the mandatory clinical assessment is not sufficient or risk factors for fractures (osteoporosis, malignoma) are known.