Mutual exclusivity of neck of femur and pubic ramus fractures in the elderly. Is it a fact?

Abstract

Background: In the emergency department, it is not uncommon to treat an elderly patient who is nonweight bearing after a fall. In some clinical situations when the plain radiographs do not show any obvious fractures, the clinician always wants to ensure that an occult femoral neck fracture is not missed. In other situations, the radiograph may show only a pubic ramus fracture. The clinical concern includes whether or not it is safe to mobilize the patient. We sought to determine how many elderly patients had simultaneous fractures of the femoral neck and pubic ramus after a trivial fall. Methods: We evaluated all patients who were admitted between April 2007 through April 2010 with a diagnosis of a femoral neck fracture after a fall from standing height. There were 300 patients (75 men and 225 women). The average age was 82 years (range, 65-101 years). All patients had plain radiographs of the pelvis and ipsilateral hip on admission. One hundred and ninety-nine patients (66.3%) had an intracapsular femoral neck fracture, and 101 (33.6%) had an extracapsular femoral neck fracture. Trained radiologists reviewed all radiographs. Results: In our study no simultaneous fractures of the femoral neck and pubic ramus were noted after a trivial fall in elderly patients. Conclusions: Based on the results we can suggest that in elderly patients femoral neck fractures appear to be mutually exclusive frompubic ramus fractures. We also can suggest that a femoral neck fracture is unlikely in elderly patients who are admitted nonweight bearing after a fall with a pubic ramus fracture on radiographs. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.