Disclosures: The authors report no relevant financial disclosures.
June 21, 2021
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CT capsular sign, lipohemarthrosis prevented unplanned surgery for femoral shaft fracture

Disclosures: The authors report no relevant financial disclosures.
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Published results showed use of CT capsular sign with lipohemarthrosis may effectively prevent unplanned surgery due to delayed diagnosis of occult ipsilateral femoral neck fractures in patients with high-energy femoral shaft fractures.

Researchers evaluated the CT capsular sign with lipohemarthrosis of the hip joint in 156 patients with high-energy femoral shaft fractures without a preoperative diagnosis of an ipsilateral femoral neck fracture. Researchers considered the CT capsular sign with lipohemarthrosis to be positive when the side-to-side difference in anterior capsular distension was greater than 1 mm and lipohemarthrosis was seen on soft tissue-window CT images.

Researchers preoperatively diagnosed eight patients with displaced or hairline ipsilateral femoral neck fractures, while the remaining 148 patients had no ipsilateral femoral neck fractures on radiographs and bone-window CT images. Researchers identified a positive CT capsular sign with lipohemarthrosis in 19.6% of the 148 patients on soft tissue-window CT images.

Among patients with a positive sign, three patients underwent preoperative MRI and 26 patients underwent prophylactic femoral neck fixation with a reconstruction nail, according to results. Overall, researchers identified five occult ipsilateral femoral neck fractures among the patients with a positive sign: two on preoperative MRI scans, two on immediate postoperative radiographs and one on 6-week postoperative radiographs. Results showed no occult ipsilateral femoral neck fractures were identified in the 119 patients with a negative sign. Researchers noted all occult ipsilateral femoral neck fractures healed without further displacement of the femoral neck, and no patients required additional unplanned surgery for delayed diagnosis of occult ipsilateral femoral neck fracture.