Dual-energy computed tomography may reduce delayed diagnosis of occult hip fractures: Experiences at a single center

Early surgical intervention within 48 h is critical for reducing mortality and morbidity in patients with hip fractures. However, occult hip fractures are often missed, leading to treatment delays. Dual-energy computed tomography allows visualization of bone marrow edema and bone contusions, which are challenging to detect using conventional computed tomography. This study aimed to evaluate the effectiveness of dual-energy computed tomography in diagnosing occult hip fractures.

Eighteen dual-energy computed tomography scans obtained between May 2018 and March 2024 were analyzed. Magnetic resonance imaging was performed in all cases. A trained musculoskeletal radiologist interpreted the dual-energy computed tomography and magnetic resonance imaging scans, which were then reviewed by two senior orthopedic surgeons. The confirmed diagnoses included 14 femoral trochanteric fractures and 4 femoral neck fractures. Four junior orthopedic surgeons independently reviewed the dual-energy computed tomography scans only and conducted diagnostic examinations. Patients were subsequently categorized into two groups: those with unanimous diagnostic agreement (unanimity group) and those with discrepancies (objection group).

For femoral trochanteric fractures, sensitivity, specificity, accuracy, and Cohen's kappa coefficient were 94%, 81%, 0.91, and 0.75, respectively. For femoral neck fractures, sensitivity, specificity, accuracy, and Cohen's kappa coefficient were 68%, 96%, 0.90, and 0.69, respectively. A significant difference in diagnostic ease was noted (p = 0.04), with agreement achieved for 12 of the 14 femoral trochanteric fractures and one of the four femoral neck fractures. Logistic regression analysis yielded a regression coefficient for femoral trochanteric fractures of 3.05 (p = 0.03), indicating that these fractures were more easily diagnosed than femoral neck fractures.

Dual-energy computed tomography demonstrated high sensitivity and specificity in detecting occult hip fractures, particularly those of the femoral trochanter. However, its sensitivity was lower for femoral neck fractures, indicating limited reliability in their diagnosis. Further investigation and magnetic resonance imaging scans are recommended for suspected femoral neck fractures.