Physical Examination has been Paid Less Attention in Elderly Patients Admitted for Suspected Fracture of the Femoral Neck following the Introduction of MRI

Abstract:
Magnetic Resonance Imaging (MRI) became routinely available in our institution since 2013 for evaluation of patients presenting with high clinical suspicion of a proximal femoral fracture (PFF). The purpose of this study was to learn if availability of MRI, could be responsible for decline in H/PE among physicians.

Methods:
Retrospective medical files of patients admitted between the years 2013 - 2017 for the evaluation of a suspected PFF by MRI were included. The number of positive scans for PFFs and the population characteristics were recorded.

Results:
182 patients comprised the study population. In 2013, 2014,2015,2016,2017 we performed an MRI scan for 6 (20%), 10 (28.6%), 18 (46%), 25 (57%), 26 (79%) of the hospitalized patients respectively and the rates of positive scans were 2 (7%), 7 (20%), 8 (20.5%), 21 (47%), 1 (3%) respectively. There was a high degree of negative correlation between the number of MRI scans performed and the rate of PFF diagnosis (r = -0.86) from year to year.

Discussion:
As MRI became routinely available, we observed a constant year to year increase in the number of scans ordered, and a constant decline in the rate of positive scans for PFFs.

Conclusions:
There is a close negative relationship between the introduction of modern diagnostic device for evaluation of occult PFFs and the attention paid to H/PE by both, residents and senior orthopedic surgeons.