ABSTRACT
Background: Due to demographic changes, proximal femoral fractures (PFF) in the elderly rise constantly. The standard diagnostic tool is still the X-ray of the pelvis/hip in two planes. Our hypothesis was that the lateral-view X-ray has little influence on classification, planning of the operative procedure, and choice of implant in geriatric patients. Methods: Retrospective analysis of all initial X-rays of PFF in geriatric patients (≥70 years) from May 2018 until August 2019 in a Level I Trauma center. Three experienced consultants categorized the fractures on the ap pelvis view and performed Garden and Pauwels classification as well as a two-staged classification displaced/nondisplaced [for femoral neck fractures (FNF)] or AO Classification [for intertrochanteric fractures (ITF)]. Afterward, they decided the operative strategy as well as implant choice [dynamic hip screw (DHS), intramedullary nail (IMN), or arthroplasty]. After 4 weeks, they categorized all fractures again with now available lateral view X-rays in a different order. Results: Two hundred seven patients (146 female, 61 male; 70.5 vs. 29.5%) with 90 FNF and 117 ITF (43.5 vs. 56.5%) could be included. Age was 84.6 ± 6.9 years. The treatment was in 45 cases DHS, in 82 cases IMN, and for the other 80 cases arthroplasty. The interobserver reliability of the classifications were poor, except for the two-staged classification [Fleiss-κ ap view only = 0.708 (CI 95% 0.604, 0.812) vs. additional lateral = 0.756 (CI 95% 0.644, 0.869)]. Moreover, independent from the classification, there were no significant changes in management and choice of implant with additional lateral view. Conclusions: Regarding our results, we consider the lateral view dispensable for standard X-ray of displaced PFF in geriatric patients. In nondisplaced fractures, it could be added secondary.
ABSTRACT
BACKGROUND: Pedicle screw fixation is commonly used in the treatment of spinal pathologies. While the biomechanical factors that affect bone fixation have been frequently described, questions remain as to which imaging modality is the ideal medium for preoperative planning. Due to its perceived superiority in assessing bony changes, computed tomography (CT) scan is assumed to be the gold standard for preparative planning, and we hypothesize that magnetic resonance imaging (MRI) is sufficiently accurate to predict screw length and diameter compared to CT. METHODS: We retrospectively measured the length and diameter of vertebral bodies in the lumbar region in both MRI and CT and tested for differences between the modalities as well as for confounding effects of age, sex, and the presence of spondyloarthrosis. RESULTS: We found a significant difference in pedicle screw length between CT and MRI measurements for both sides. For the left pedicle, the mean difference was 1.89 mm (95% confidence interval [CI] -3.03 to -0.75; P < .002), while for the right pedicle, the mean difference was 2.05 mm (95% CI -3.27 to -0.84; P = .001). We also found a significant difference in diameter measurements between CT and MRI for the left pedicle (0.53 mm; 95% CI 0.13 to 0.93; P = .011) but not for the right pedicle (0.36 mm; 95% CI -0.06 to 0.78; P = .094). We identified no significant effect of sex, age or spondyloarthrosis on the results (P > .05). CONCLUSIONS: Pedicle screw planning measurements were more accurate using CT images compared to MRI images. CT scan remains the gold standard for pedicle screw planning in trauma surgery. When using MRI images, the surgeon should be aware of the differences in screw length and diameter compared to CT in order to avoid intra- and postoperative risks.
