Clinical characteristics and long-term mortality of occult hip fracture elderly patients Yichayaou Beloosesky a, *, Avital Hershkovitz b , Alexandr Guz a , Haim Golan c , Moshe Salai d , Avraham Weiss a a Department of Geriatrics, Rabin Medical Centre, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, 49372 Petach Tikvah, Israel b Beit Rivka, Geriatric Rehabilitation Hospital, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel c Department of Nuclear Medicine, Assaf Harofeh Medical Centre, Sackler School of Medicine, Tel Aviv University, Zerifin, Israel d Department of Orthopedics, Rabin Medical Centre, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel Introduction Hip fracture is one of the most common and serious injuries experienced by the elderly and is expected to increase worldwide to 2.6 million by 2025. 7,19 Rapid diagnosis and management of hip fractures have valuable prognostic implications. 9,18,30 Diagnosis is usually made by standard plain radiography. However, occult fractures occur in 2–9% of patients. 2,5,23,25 In these cases, magnetic resonance imaging (MRI), not widely available, is the preferred investigation tool essential for diagnosis. Alternatively a bone scan can be utilized. 5,14,26,29 Very little is known about the clinical characteristics of elderly patients with occult hip fractures (OHF). Several studies investigating the use of MRI in hip and pelvic occult fracture, did not include characteristic clinical information about the patients. 2,5,16,17,21,29 Only one retrospective study, using an MRI, attempted to clinically characterize these patients. 11 To our knowledge no previous study has compared the clinical features of OHF patients with plain radiography diagnosed hip fracture patients. Our objectives were (1) to investigate and compare the clinical characteristics and long-term mortality of OHF elderly patients diagnosed by bone scan, with randomly chosen hip fractured patients diagnosed by plain radiography and (2) to determine if a certain subgroup of patients would benefit from an MRI investigation following normal or equivocal radiography. Methods Study design This retrospective cohort study took place in the Department of Geriatrics, Beilinson Hospital and in the Department of Nuclear Medicine, Hasharon Hospital, Rabin Medical Centre, Petach Tikvah, Injury, Int. J. Care Injured 41 (2010) 343–347 ARTICLE INFO Article history: Accepted 17 August 2009 Keywords: Occult hip fracture Elderly Clinical characteristics Long-term mortality ABSTRACT Background and objective: Occult hip fractures (OHF) occur in a minute population of patients. Diagnosis is made via magnetic resonance imaging (MRI) or alternatively via bone scan. Very little is known about the clinical characteristics of OHF patients. Our aim was to characterize the clinical and long-term survival of OHF in elderly patients and to determine if a certain subgroup of patients would benefit from an MRI investigation following normal or equivocal radiography. Methods: Twenty-nine OHF patients diagnosed by a bone scan during 1995–2004 were compared with a control group of 94 randomly chosen hip fractured patients diagnosed by plain radiography in the same hospital and during the same period. Results: Mean age, women/men ratio, place of residence, comorbidities, cognitive and functional status were similar in the OHF and control group. Twenty-two (75.9%) and 4 (13.8%) patients in the OHF group had had subcapital and intertrochanteric fractures respectively, vs. 41 (43.6%) and 47 (50%) in the control group (p = 0.003). Diagnosis delay in the OHF group was 16.8  26.5 days vs. 2.5  2.9 days (p < 0.001) in the control group. There were fewer operations and complications in the OHF group compared to the control group (p < 0.001 and p = 0.017, respectively). During a 13-year follow-up, no differences in survival were found between the two groups nor any differences between those operated on and those who were not. Conclusions: OHF patients have no distinctive clinical characteristics or long-term survival. The delay in diagnosing OHF is too much long and is probably related to the high prevalence of conservative treatment. MRI investigation is recommended whenever OHF are suspected and surgical treatment is considered, in order to improve diagnosis and treatment. ß 2009 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +972 3 937 6820; fax: +972 3 937 6817. E-mail address: beloy@clalit.org.il (Y. Beloosesky). Contents lists available at ScienceDirect Injury journal homepage: www.elsevier.com/locate/injury 0020–1383/$ – see front matter ß 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2009.08.017