The use of computed tomography in identifying radiologically occult hip fractures in the elderly.

INTRODUCTION: Fractured neck of femur (NOF) is a cause of significant morbidity and mortality. Approximately 4% of patients with an initial normal hip x-ray in the emergency department (ED) will in fact have an occult fracture. In cases where there is ongoing clinical suspicion of NOF fracture despite a normal hip x-ray, alternative imaging should be used. Although available evidence supports the use of magnetic resonance imaging (MRI) for this, it is often not readily accessible from the ED. In our department, it is common practice to request computed tomography (CT). METHODS: A historical review was undertaken of all patients who presented between October 2007 and January 2011 who had CT requested by ED staff. Patients included in the study were those who presented following low impact trauma in whom fractured NOF was suspected despite a normal x-ray. RESULTS: Of the 65 included patients, fractures (pelvic and hip) were identified in 38 patients on CT. Fractured NOFs were found in 13 patients. Acetabular fractures were found in nine patients, five of whom required further orthopaedic management. One patient went on to have MRI to confirm the diagnosis of an impacted NOF fracture, suspected both on x-ray and CT. Further review was undertaken of the medical notes of discharged patients to identify any who reattended or required further imaging. No such cases were found. CONCLUSIONS: This review has shown the use of CT to be a practical approach to improving the care of patients with occult hip fractures.

Body mass index and its effects on retinal vessel diameter in 6-year-old children.

PURPOSE: To examine the relationship between body mass index (BMI) and other anthropometric measures with retinal vessel diameter in children. METHODS: A random cluster sample of 34 schools was selected in the Sydney metropolitan area during 2003-04, and 1740 children aged 6 years participated in The Sydney Childhood Eye Study. Retinal images were taken and vessel diameter was measured using a computer-imaging program. Anthropometric measures, including weight, height, waist circumference, BMI and body surface area (BSA), were obtained and defined using standardized protocols. Data on confounders, including ocular parameters, ethnicity, birth parameters and blood pressure, were similarly collected. RESULTS: Mean BMI was 16.2 kg/m(2) (+/-2.1 s.d.) in 1608 (92.4%) children with complete data. After controlling for age, sex, ethnicity, axial length of the eyeball, birth weight and mean arterial blood pressure, children with BMI above the cardiovascular risk threshold (defined as BMI>16.1 kg/m(2) in boys and BMI>15.9 kg/m(2) in girls) had mean retinal venular diameter 2.1 microm larger than those with BMI below this threshold (P=0.026). Increasing weight and BSA were also positively associated with wider retinal venules. Children in the highest quartile of BMI had mean retinal arteriolar diameter 2.2 microm smaller than those in the lowest quartile. Increasing waist circumference and shorter height were also associated with narrower retinal arterioles. CONCLUSIONS: In this sample of 6-year-old children, greater BMI, weight and BSA were associated with wider retinal venules, while greater BMI and larger waist circumference were associated with narrower retinal arterioles. These findings suggest a possible effect of increased body mass and adiposity on early microvascular structural alterations in childhood, long before the development of cardiovascular disease.