This study addresses a well-known diagnostic pitfall in trauma: femoral neck fractures that occur alongside femoral shaft fractures are frequently missed on initial imaging. The authors set out to test whether axial-view CT of the pelvis outperforms plain radiographs (AP pelvis and AP femur) in detecting these associated neck fractures. They assembled a blinded, randomized image set from 28 patients with femoral shaft fractures who also had a femoral neck fracture and 60 patients with isolated femoral shaft fractures. Five trauma fellowship-trained orthopaedic surgeons, blinded to clinical diagnosis and treatment, independently reviewed the de-identified images and rated them for the presence of a femoral neck fracture. Sensitivity, specificity, and post-test probabilities were calculated for each imaging modality.
• This tells trainees that no single imaging modality—including axial CT—reliably rules out an occult femoral neck fracture in the setting of an ipsilateral femoral shaft fracture; roughly one-third to nearly half of these fractures can be missed regardless of which image is used. • It reinforces why intraoperative fluoroscopy and postoperative imaging remain necessary safety nets, rather than relying solely on preoperative CT or radiographs to clear the femoral neck. • For residents, this is a good reminder to maintain a high index of suspicion and repeat imaging vigilance any time a femoral shaft fracture is encountered, since sensitivity limitations are inherent to the imaging itself, not just reader error.
This study addresses a well-known diagnostic pitfall in trauma: femoral neck fractures that occur alongside femoral shaft fractures are frequently missed on initial imaging. The authors set out to test whether axial-view CT of the pelvis outperforms plain radiographs (AP pelvis and AP femur) in detecting these associated neck fractures. They assembled a blinded, randomized image set from 28 patients with femoral shaft fractures who also had a femoral neck fracture and 60 patients with isolated femoral shaft fractures. Five trauma fellowship-trained orthopaedic surgeons, blinded to clinical diagnosis and treatment, independently reviewed the de-identified images and rated them for the presence of a femoral neck fracture. Sensitivity, specificity, and post-test probabilities were calculated for each imaging modality.
• This tells trainees that no single imaging modality—including axial CT—reliably rules out an occult femoral neck fracture in the setting of an ipsilateral femoral shaft fracture; roughly one-third to nearly half of these fractures can be missed regardless of which image is used. • It reinforces why intraoperative fluoroscopy and postoperative imaging remain necessary safety nets, rather than relying solely on preoperative CT or radiographs to clear the femoral neck. • For residents, this is a good reminder to maintain a high index of suspicion and repeat imaging vigilance any time a femoral shaft fracture is encountered, since sensitivity limitations are inherent to the imaging itself, not just reader error.