PDF(Pubmed)
Abstract：
Background: Occult fractures may cause multiple morbidities. If occult fractures were detected earlier, complications may be preventable. This umbrella review and updated meta-analysis will aim to evaluate the use of imaging modalities in detecting occult scaphoid and hip fractures. Methods: The protocol for this study is available in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024525388). The literature search started and ended on 17 March 2024. We searched seven academic databases: MEDLINE, Cochrane Library, Pubmed, Science Direct, Google Scholar, WHO International Clinical Trials Registry Platform, and The Joanna Briggs Institute (JBI) database. The meta-analysis was conducted with the STATA program using the \"midas\" command. Results: There are four systematic reviews evaluating occult hip and femoral fractures with 6174 patients and two reviews evaluating occult scaphoid fractures with 1355 patients. The prevalence of occult scaphoid fracture and occult hip and femoral fractures is 23.87% (95% CI 18.25-29.49) and 44.8% (95% CI 39.38-51.4), respectively. Magnetic resonance imaging (MRI) had the best posterior probability of positive likelihood ratio (LR+) with 95% and 96% and negative likelihood ratio (LR-) with 0.15% and 1% for both occult scaphoid and hip fractures, respectively, assuming a 25% baseline. MRI could both confirm and exclude occult hip fractures while it can only confirm occult scaphoid fractures. Bone scans are inappropriate for either type of occult fractures The level of evidence for occult scaphoid fracture is weak while it is suggestive for occult hip fractures. Conclusion: The findings strengthen the use of MRI after an initially negative radiograph fracture for occult hip and femoral fractures, with a CT scan as a viable second option.
摘要：
背景：隐匿性骨折可引起多种并发症。如果早期发现隐匿性骨折，并发症是可以预防的。这项综述和更新的荟萃分析旨在评估成像方式在检测隐匿性舟骨和髋部骨折中的应用。方法：本研究的方案可在国际前瞻性系统审查注册（PROSPERO）数据库（CRD42024525388）中获得。文献检索开始并于2024年3月17日结束。我们搜索了七个学术数据库：MEDLINE,科克伦图书馆,Pubmed,科学直接，谷歌学者，世卫组织国际临床试验注册平台，和JoannaBriggs研究所（JBI）数据库。使用STATA程序使用“midas”命令进行荟萃分析。结果：对6174例隐匿性髋部和股骨骨折进行了4项系统评价，对1355例隐匿性舟骨骨折进行了2项评价。隐匿性舟骨骨折和隐匿性髋部和股骨骨折的患病率分别为23.87％（95％CI18.25-29.49）和44.8％（95％CI39.38-51.4），分别。对于隐匿性舟骨和髋部骨折，磁共振成像（MRI）具有阳性似然比（LR）的最佳后验概率，分别为95％和96％，阴性似然比（LR-）分别为0.15％和1％。分别,假设基线为25%。MRI可以确认和排除隐匿性髋部骨折，而只能确认隐匿性舟骨骨折。骨扫描不适用于两种隐匿性骨折。隐匿性舟骨骨折的证据水平较弱，但提示隐匿性髋部骨折。结论：对于隐匿性髋部和股骨骨折，X线片初始阴性骨折后，这些发现加强了MRI的使用。以CT扫描作为可行的第二种选择。
