Occult femoral neck fractures

Occult femoral neck fractures: alternative case of REMS application

 Nikola Kirilov 1, Fabian Bischoff 2, Stoyanka Vladeva 3, and Elena Bischoff 4

1 Department of Orthopedics and Traumatology, Faculty of Medicine, Medical University—Pleven, 5800 Pleven, Bulgaria

2 IPSMP Rheumatology, 6000 Stara Zagora, Bulgaria; bischoff.f@web.de

3 Department of Health Care, Faculty of Medicine, Trakia University, 6015 Stara Zagora, Bulgaria; drvladeva@abv.bg

4 Faculty of Public Health and Healthcare, University “Prof Dr Asen Zlatarov”— Burgas, 8010 Burgas, Bulgaria; elenabischoffmd@web.de

HIGHLIGHT:

A recent international study conducted in the field of orthopedics showed that the application of technology Radiofrequency Echographic Multi Spectrometry (REMS), in addition to providing the simultaneous osteoporosis diagnosis and fracture risk assessment, it also detects occult femoral neck fractures.

Occult fractures represent a type of nondisplaced fracture, which are not visible on plain radiographs or, sometimes, not even with computed tomography (CT). In this case-study a 91-year-old woman with persistent pain in her right leg and a family history of arthritis and osteoporosis was analyzed. After a fall on the right side, the patient underwent diagnostic tests: X-ray, REMS and CT. The simple X-ray of the right hip was not able to detect signs of fracture, on the contrary, the REMS ultrasound scan revealed osteoporosis and damage in the femoral cortex, attributable to a possible fracture. The presence of such a femoral neck fracture was confirmed by CT. Therefore, it is now shown that REMS technology delivering precise bone mineral density estimation and fracture risk calculation, additionally offers the possibility to reveal occult femoral neck fractures, especially in bedridden patients and when the use of other diagnostic techniques is limiting.