Journal of Trauma and Injury

Case Report

Rare Imaging of Fat Embolism Seen on Computed Tomography in the Common Iliac Vein after Polytrauma: Hojun Lee, Jonghwan Moon, Junsik Kwon, John Cook-Jong Lee; J Trauma Inj. 2018;31(2):103-106. Published online August 31, 2018; DOI: https://doi.org/10.20408/jti.2018.31.2.103

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Fat embolism refers to the presence of fat droplets within the peripheral and lung microcirculation with or without clinical sequelae. However, early diagnosis of fat embolism is very difficult because the embolism usually does not show at the computed tomography as a large fat complex within vessels. Forty-eight-year-old male with pedestrian traffic accident ransferred from a local hospital by helicopter to the regional trauma center by two flight surgeons on board. At the rendezvous point, he had suffered with dyspnea without any airway obstruction sign with 90% of oxygen saturation from pulse oximetry with giving 15 L of oxygen by a reserve bag mask. The patient was intubated at the rendezvous point. The secondary survey of the patient revealed multiple pelvic bone fracture with sacrum fracture, right femur shaft fracture and right tibia head fracture. Abdominal computed tomography was performed in 191 minutes after the injury and fat embolism with Hounsfield unit of ?86 in his right common iliac vein was identified. Here is a very rare case that mass of fat embolism was shown within common iliac vein detected in computed tomography. Early detection of the fat embolus and early stabilization of the fractures are essential to the prevention of sequelae such as cerebral fat embolism.

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Fat embolism in the popliteal vein detected on CT: Case report and review of the literature
Tucker Burr, Hamza Chaudhry, Cheryl Zhang, Vasilios Vasilopoulos, Emad Allam
Radiology Case Reports.2020; 15(11): 2308. CrossRef

Original Articles

The Consequence of Delayed Diagnosis of an Occult Hip Fracture: Sangbong Je, Hyejin Kim, Seokyong Ryu, Sukjin Cho, Sungchan Oh, Taekyung Kang, Seungwoon Choi; J Trauma Inj. 2015;28(3):91-97. Published online September 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.3.91

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PURPOSE
Occult hip fracture is not evident on radiographs and the diagnosis is often missed or delayed. This study was undertaken in order to identify the clinical characteristics and complications of patients with a delayed diagnosis of an occult hip fracture.
METHODS
We retrospectively reviewed patients with occult hip fracture who had normal findings on initial radiographs, the diagnosis was made on additional studies between August 2006 and February 2012. Patients who were diagnosed as having occult hip fractures at the first visit were categorized as non-delayed group and those who were not diagnosed at the first visit were categorized as delayed group.
RESULTS
Non-delayed group included 43 patients (86%). In the remaining 7 patients (delayed group), the diagnosis was delayed by a mean of 9.6 days (range 3~19 days). Patients who were diagnosed with an occult fracture on the initial visit presented later than those with a delayed diagnosis (41/43 .vs. 3/7, p=0.002). Other clinical features were no difference between the two groups. Patients in the delayed diagnosis group were more likely to have fracture displacement (4/7 .vs. 0/43)15patients in non-delayed group (34.9%) needed operative treatment, whereas all delayed patients (100%) needed operative treatment.
CONCLUSION
A delayed diagnosis of occult hip fractures was associated with increased rate of displacement and operation. In patients suspected of having occult hip fractures, additional studies should be recommended.

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APPLICATION OF ARTIFICIAL INTELLIGENCE TO ASSIST HIP FRACTURE DIAGNOSIS USING PLAIN RADIOGRAPHS
Phichai Udombuathong, Ruthasiri Srisawasdi, Waravut Kesornsukhon, San Ratanasanya
Journal of Southeast Asian Medical Research.2022; 6: e0111. CrossRef
Differential diagnosis of acute traumatic hip pain in the elderly
Matthew Hampton, Richard Stevens, Adrian Highland, Richard Gibson, Mark B Davies
Acta Orthopaedica Belgica.2021; 87(1): 1. CrossRef
The Necessity of CT Hip Scans in the Investigation of Occult Hip Fractures and Their Effect on Patient Management
Thomas Gatt, Daniel Cutajar, Lara Borg, Ryan Giordmaina, Panagiotis Korovessis
Advances in Orthopedics.2021; 2021: 1. CrossRef
Clinical characteristics and short to mid term functional outcomes of surgically treated occult hip fractures in the elderly
Sean W.L. Ho, Lynn Thwin, Ernest B.K. Kwek
Injury.2018; 49(12): 2216. CrossRef

Characteristics of Patients with Occult Hip Fracture after Hip Trauma: Wookhyun Yu, Hyejin Kim, Sukjin Cho, Sungchan Oh, Taekyung Kang, Seungwoon Choi, Seokyong Ryu; J Trauma Inj. 2013;26(3):125-130.

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Abstract PDF: PURPOSE
This study was undertaken in order to identify the characteristics of patients diagnosed with occult an hip fracture after hip trauma.
METHODS
We retrospectively reviewed the medical records and radiology reports of all patients who underwent hip skeletal computed tomography (CT) for suspected hip fractures but had normal initial X-rays after hip trauma between August 2006 and January 2012. The variables evaluated included age, gender, body mass index (BMI), accident mechanism, previous fracture, independence, late presentation, ability to bear weight, pain on passive rotation, tenderness of the groin area, diagnosis and treatment. Patients were divided into two groups, with hip fracture (occult hip fracture group) and without hip fracture (no fracture group) to evaluate the characteristics associated with an occult hip fracture.
RESULTS
The patients, a total of 139, had a mean age of 58.3 years and included 72 male patients(51.8%). The occult hip fracture group included 43 patients(30.9%). Of those 43, 21 patients(48.8%) had intertrochanteric or trochanteric fractures, 8 patients(18.6%) had femur neck fractures and 14 patients(32.6%) had acetabular fractures. Of the 43, 15 patients(34.9%) needed operative treatment. Age was higher in the occult hip fracture group than it was in the no fracture group(64.4+/-19.1 years vs. 55.5+/-23.6 years, p=0.021). A previous fracture was associated with the presence of a new fracture (p=0.014; OR=3.971, 95% CI=1.314-11.997).
CONCLUSION
Further evaluation of patients who are older or have history of fractures is prudent, even though the initial X-rays are normal.; Summary

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