Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


Fragility Fractures “Small Fall, Large Costs”

  • Plain films miss fractures; 3.1% of all ED patients with "negative" hip x-ray studies actually have an occult hip fracture. If still clinically suspicious, MRI is the gold standard in low energy falls.
  • Having an organized, streamlined process to admit fragility fractures with goal of time to surgery less than 24 hours improves mortality, decreases length of stay and costs, and allows for earlier mobilization.
    • Dominquez S. et al. Prevalence of traumatic hip and pelvic fractures in patients with suspected hip fracture and negative initial standard radiographs—a study of emergency department patients. Academic Emergency Medicine. 2005 Apr; 12(4):366-9
    • Verbeeten KM, et al. The advantages of MRI in the detection of occult hip fractures. Eur Radiology. Jan 2005: 15(1): 165-9
    • Cannon J, Silvestri S. Munro M. Imaging choices in occult hip fracture. J Emergency Medicine. 2009 Aug; 37 (2): 144-52
    • Kates SL, Mears SC. A guide to improving the care of patients with fragility fractures. Geriatric Orthopaedic Surgery and Rehabilitation. 2011 2(1) 5-37