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Preoperative "Computed tomography capsular sign" for the detection of occult ipsilateral femoral neck fractures associated with femoral shaft fractures

Authors
 Young-Chang Park  ;  Kyu-Sub Um  ;  Seung-Pyo Hong  ;  Chang-Wug Oh  ;  Sungjun Kim  ;  Kyu-Hyun Yang 
Citation
 INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, Vol.51(4) : 1051-1056, 2020-04 
Journal Title
 INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 
ISSN
 0020-1383 
Issue Date
2020-04
Keywords
Computed tomography ; Femoral shaft fracture ; Ipsilateral femoral neck fracture ; Occult fracture ; Preoperative evaluation
Abstract
Aim: We scrutinised the computed tomography (CT) capsular sign, which refers to the anterior capsular distension of the hip, to determine whether we can use it as an additional clue for detecting occult ipsilateral femoral neck fracture (IFNF) before operation. Patients and methods: We retrospectively examined 79 patients who suffered high-energy femoral shaft fracture and were evaluated with preoperative CT for occult IFNF. The occult IFNF was defined as a fracture that was not diagnosed confirmatively during preoperative evaluation. Thirteen patients were included in the occult IFNF group and 66 were included in the femoral neck intact group. A side-to-side difference of more than 1 mm of capsular distension was considered a positive CT capsular sign. Results: Among 13 patients in the occult IFNF group, 6 had a hairline fracture (bony window images) and 12 had a positive CT capsular sign (soft tissue window images) on preoperative CT scans. The presence of IFNF was more significantly associated with the CT capsular sign than with the hairline fracture (p = 0.031). Among the 66 patients in the femoral neck intact group, the CT capsular sign was false positive in 4. Conclusion: The CT capsular sign can be used to detect the presence of occult IFNF in high-energy trauma patients with femoral shaft fractures. During the preoperative evaluation of IFNF, surgeons must pay extra attention to the presence of occult IFNF when the CT capsular sign is positive.
Full Text
https://www.sciencedirect.com/science/article/pii/S0020138320301418
DOI
10.1016/j.injury.2020.02.067
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sungjun(김성준) ORCID logo https://orcid.org/0000-0002-7876-7901
Yang, Kyu Hyun(양규현) ORCID logo https://orcid.org/0000-0001-7183-588X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/180492
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