Misdiagnosis of occult hip fracture is more likely in patients with poor mobility and cognitive impairment.

The diagnosis of occult hip fracture is frequently missed. We wished to investigate if patients in whom occult hip fracture was initially misdiagnosed had any distinct features, and their outcome. We reviewed 297 patients who presented with hip fractures over a two-year period. There were 24 occult hip fractures, the diagnosis was initially missed in 9 patients and correctly made in the other 15. Of the correctly identified patients, 8/15 were independently mobile and 9/15 were living in their own home compared to 0/9 independently mobile and 2/9 living in own home among those with missed diagnosis (p < 0.001). Seven of nine patients with a missed diagnosis had mental confusion but none in the other 15 (p < 0.001). Eight of the nine patients with missed diagnosis of fracture had intra-capsular fractures, of which 6 secondarily displaced. Three of those nine patients died within one year from their fracture. We suggest a low threshold of investigation for occult hip fracture in the elderly, infirm and mentally confused who present to the accident department with suspected occult hip fracture.

Thromboprophylaxis and Incidence of Venous Thromboembolism in Patients With Hemophilia A or B Who Underwent High-Risk Orthopedic Surgeries.

Total hip replacement (THR) and total knee arthroplasty (TKA) carry a high risk of postoperative venous thromboembolism (VTE); therefore, anticoagulation prophylaxis is recommended in these patients. Unfortunately, there are no guidelines about VTE prophylaxis in patients with hemophilia who underwent these high-risk surgeries. To determine whether these patients have high risk of VTE, we conducted a retrospective study on patients with hemophilia who underwent elective THR/TKA at our institute from 2004 to 2012. Postoperatively, we collected information on duration and method of factor VIII/IX infusion, VTE-prophylaxis, and complications. There were 23 patients with hemophilia, 18 (78%) with hemophilia A and 5 (22%) with hemophilia B, who underwent high-risk surgeries (39% THR and 61% TKA). The VTE prophylaxis included sequential compression device, 12 (52%), and prophylactic enoxaparin, 1 (4%). Ten (43%) patients did not receive VTE prophylaxis. At 1-year follow-up, we did not find any evidence of clinical VTE in our patients. Better risk stratification is needed to identify patients who would benefit from pharmacological prophylaxis.

Complications of renal transplantation.

Continued improvements in graft survival have led to widespread acceptance of renal transplantation as the preferred treatment for the majority of patients with end-stage renal disease. The long-term care of these patients is often provided away from transplantation centers. This article presents both the clinical and imaging features of renal transplantation complications and their interventional management. Urologic and vascular complications may occur. Vascular complications include renal artery stenosis and renal artery and renal vein thrombosis. Ultrasound can accurately depict and characterize many of the potential complications of renal transplantation and increasingly magnetic resonance imaging also facilitates this role. In addition, interventional radiologic techniques allow nonsurgical treatment.

Multidetector CT urography: techniques, clinical applications, and pitfalls.

For two decades, computed tomography (CT) has challenged intravenous urography (IVU) in the evaluation of urinary tract abnormalities. Compared with IVU, CT is more sensitive and specific in the detection and characterization of a variety of urinary tract disorders, including renal masses and urolithiasis. The last purported advantage of IVU has been its ability to depict subtle and mucosal abnormalities of the urothelium. Now, using multidetector CT (MDCT), this challenge has been overcome. In this article, we review the current role of MDCT urography in the evaluation of the urinary tract.

Multi-detector row CT urography of normal urinary collecting system: furosemide versus saline as adjunct to contrast medium.

PURPOSE: To retrospectively evaluate whether intravenous furosemide, either alone or in addition to intravenous saline, improved depiction of the normal urinary collecting system at multi-detector row computed tomographic (CT) urography. MATERIALS AND METHODS: Institutional review board approval for review of patient images and medical records was obtained; informed consent was not required for this HIPAA-compliant study. Excretory phase images from multi-detector row CT urography in 87 patients (44 women, 43 men; age range, 21-83 years; mean, 53 years) were reviewed. Examinations were performed with, in addition to intravenous contrast medium, 250 mL of intravenous normal saline alone (n = 35), both 250 mL of normal saline and 10 mg of intravenous furosemide (n = 26), or 10 mg of furosemide alone (n = 26). Three readers, blinded to the imaging technique used, individually assigned opacification scores to each of six urinary collecting system segments. Urinary distention was assessed by one reader by measuring transverse widths of the proximal, middle, and distal ureteral segments. Mean opacification scores for each segment and mean ureteral width measurements for each technique were compared by using the Student t test. RESULTS: Mean opacification scores achieved with furosemide were significantly higher than those achieved with saline for the middle (P