{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T12:48:53Z","timestamp":1790858933369,"version":"4.1.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","funder":[{"DOI":"10.13039\/spkajuiqrkzc","name":"National Center for Advancing Translational Science (NCATS) of the National Institutes of Health","doi-asserted-by":"publisher","award":["UL1TR001855"],"award-info":[{"award-number":["UL1TR001855"]}],"id":[{"id":"10.13039\/spkajuiqrkzc","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/sphkgj1kfoqf","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","award":["BPS-2024C1-37436"],"award-info":[{"award-number":["BPS-2024C1-37436"]}],"id":[{"id":"10.13039\/sphkgj1kfoqf","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/sptkj3nckahq","name":"Orthopaedic Trauma Association","doi-asserted-by":"publisher","award":["Full Member Research Grant"],"award-info":[{"award-number":["Full Member Research Grant"]}],"id":[{"id":"10.13039\/sptkj3nckahq","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"\n OBJECTIVES:<\/jats:title>\n To determine if axial computerized tomography (CT) images compared with radiographs of minimally displaced femoral neck fractures in older adults change surgeons' estimates of posterior tilt or treatment preference for internal fixation versus arthroplasty.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n <\/jats:sec>\n \n Design:<\/jats:title>\n A survey was developed from the clinical vignettes, injury radiographs of anteroposterior (AP) pelvis and lateral hip, and CT pelvis axial images of 10 patients randomly selected from 50 patients with minimally displaced femoral neck fractures enrolled in a clinical trial. Survey respondents estimated femoral neck fracture posterior tilt angle (0\u201390 degrees) and stated their treatment preference on a scale of 100% for internal fixation to 100% for arthroplasty based on the radiographs, then again after viewing the CT images of the same patient.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n The survey was administered electronically using REDCap and distributed by email between 15 June and 15 July 2025.<\/jats:p>\n <\/jats:sec>\n \n Patient Selection Criteria:<\/jats:title>\n The survey was distributed to a convenience sample of attending orthopaedic surgeons with hip fracture call experience nonrandomly selected from email contacts of colleagues, acquaintances, and extramural research collaborators located in North America, South America, and Europe. Neither fellowship training nor practice setting were requirements for participation.<\/jats:p>\n <\/jats:sec>\n \n Outcome Measures and Comparisons:<\/jats:title>\n The mean differences in posterior tilt estimates and treatment preferences between radiographs and CT were estimated using linear mixed-effects models.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n Complete survey responses were received from 69 of 98 participants (70.4% response rate). Posterior tilt estimates were 6 degrees greater based on CT versus radiographs (95% confidence interval [CI], 4\u20137 degrees;\n P<\/jats:italic>\n < 0.0001). CT images significantly changed treatment preferences by 20% more in favor of arthroplasty (95% CI, 14%\u201326%;\n P<\/jats:italic>\n < 0.0001).\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Axial CT images significantly changed orthopaedic surgeons' estimates of posterior tilt and treatment preferences in favor of arthroplasty for minimally displaced femoral neck fractures compared with radiographs.<\/jats:p>\n <\/jats:sec>\n \n LEVEL OF EVIDENCE:<\/jats:title>\n Prognostic Level V. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/bot.0000000000003186","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T18:02:31Z","timestamp":1778004151000},"page":"e186-e191","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Do Computerized Tomography Images Influence Surgeons' Estimates of Posterior Tilt Angle or Treatment Preference for Minimally Displaced Femoral Neck Fractures?"],"prefix":"10.1097","volume":"40","author":[{"given":"Soroush","family":"Shabani","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan N.","family":"O'Hara","sequence":"additional","affiliation":[{"name":"Center for Orthopaedic Injury, Research, and Innovation, Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan C.","family":"Ross","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Wier","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Gasho","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila","family":"Sprague","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard P.","family":"Slobogean","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California Irvine, Irvine, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7494-7366","authenticated-orcid":false,"given":"Joseph T.","family":"Patterson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"MDFN Fracture Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20260809","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/BF01623184","article-title":"Hip fractures in the elderly: a world-wide projection","volume":"2","author":"Cooper","year":"1992","journal-title":"Osteoporos Int"},{"key":"R2-20260809","doi-asserted-by":"crossref","first-page":"2158","DOI":"10.1016\/j.injury.2019.09.039","article-title":"Outcomes of elderly patients with nondisplaced or minimally displaced femoral neck fractures treated with internal fixation: a systematic review and meta-analysis","volume":"50","author":"Overmann","year":"2019","journal-title":"Injury"},{"key":"R3-20260809","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s00590-025-04412-3","article-title":"When would orthopaedic surgeons perform arthroplasty for a femoral neck fracture in an older adult?","volume":"35","author":"De Maria Prieto","year":"2025","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"R4-20260809","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1016\/S0140-6736(17)30066-1","article-title":"Fixation using alternative Implants for the Treatment of Hip fractures (FAITH) Investigators. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial","volume":"389","year":"2017","journal-title":"Lancet"},{"key":"R7-20260809","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/os.12910","article-title":"Long-term efficacy of screw fixation vs hemiarthroplasty for undisplaced femoral neck fracture in patients over 65 years of age: a systematic review and meta-analysis","volume":"13","author":"Xu","year":"2021","journal-title":"Orthop Surg"},{"key":"R8-20260809","doi-asserted-by":"crossref","first-page":"136","DOI":"10.2106\/JBJS.18.00316","article-title":"Screw fixation versus hemiarthroplasty for nondisplaced femoral neck fractures in elderly patients: a multicenter randomized controlled trial","volume":"101","author":"Dolatowski","year":"2019","journal-title":"J Bone Joint Surg Am"},{"key":"R9-20260809","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s00402-016-2591-9","article-title":"Hemiarthroplasty versus internal fixation in super-aged patients with undisplaced femoral neck fractures: a 5-year follow-up of randomized controlled trial","volume":"137","author":"Lu","year":"2017","journal-title":"Arch Orthop Trauma Surg"},{"issue":"suppl 3","key":"R10-20260809","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1097\/BOT.0000000000001940","article-title":"Arthroplasty versus internal fixation for the treatment of undisplaced femoral neck fractures: a retrospective cohort study","volume":"34","author":"Afaq","year":"2020","journal-title":"J Orthop Trauma"},{"key":"R11-20260809","doi-asserted-by":"crossref","first-page":"643","DOI":"10.2340\/17453674.2022.3974","article-title":"Internal fixation or hip replacement for undisplaced femoral neck fractures? pre-fracture health differences reflect survival and functional outcome","volume":"93","author":"Ek","year":"2022","journal-title":"Acta Orthop"},{"key":"R12-20260809","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1097\/BOT.0000000000001551","article-title":"Femoral neck shortening after hip fracture fixation is associated with inferior hip function: results from the FAITH trial","volume":"33","author":"Felton","year":"2019","journal-title":"J Orthop Trauma"},{"key":"R13-20260809","doi-asserted-by":"crossref","first-page":"22","DOI":"10.3390\/geriatrics5020022","article-title":"Surgical treatment of femoral neck fractures: a brief review","volume":"5","author":"Lutnick","year":"2020","journal-title":"Geriatr (Basel)"},{"key":"R14-20260809","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1097\/BOT.0000000000001360","article-title":"Garden 1 and 2 femoral neck fractures collapse more than expected after closed reduction and percutaneous pinning","volume":"33","author":"Cronin","year":"2019","journal-title":"J Orthop Trauma"},{"key":"R15-20260809","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1097\/BOT.0000000000002621","article-title":"High complication rate after percutaneous screw fixation for valgus impacted femoral neck fractures without sagittal malalignment","volume":"37","author":"Gaski","year":"2023","journal-title":"J Orthop Trauma"},{"key":"R16-20260809","doi-asserted-by":"crossref","first-page":"303","DOI":"10.3109\/17453670902967281","article-title":"A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures","volume":"80","author":"Palm","year":"2009","journal-title":"Acta Orthop"},{"key":"R17-20260809","doi-asserted-by":"crossref","first-page":"2771","DOI":"10.1016\/j.injury.2020.09.033","article-title":"Posterior tilt in nondisplaced femoral neck fractures increases the risk of reoperations after osteosynthesis. A systematic review and meta-analysis","volume":"51","author":"Nielsen","year":"2020","journal-title":"Injury"},{"key":"R18-20260809","doi-asserted-by":"crossref","first-page":"e89","DOI":"10.1097\/BOT.0000000000002490","article-title":"Evaluation of the posterior tilt angle in predicting failure of nondisplaced femoral neck fractures after internal fixation: a systematic review","volume":"37","author":"Papadelis","year":"2023","journal-title":"J Orthop Trauma"},{"key":"R19-20260809","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1007\/s00068-021-01673-5","article-title":"More than 20\u00b0 posterior tilt of the femoral head in undisplaced femoral neck fractures results in a four times higher risk of treatment failure","volume":"48","author":"Kalsbeek","year":"2022","journal-title":"Eur J Trauma Emerg Surg"},{"key":"R20-20260809","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1097\/BOT.0b013e318281da6e","article-title":"Internal fixation of garden I and II femoral neck fractures: posterior tilt did not influence the reoperation rate in 382 consecutive hips followed for a minimum of 5 years","volume":"27","author":"Lapidus","year":"2013","journal-title":"J Orthop Trauma"},{"key":"R21-20260809","doi-asserted-by":"crossref","first-page":"2184","DOI":"10.1016\/j.injury.2017.08.053","article-title":"The influence of the hips position on measurements of posterior tilt in a valgus-impacted femoral neck fracture","volume":"48","author":"Hoelsbrekken","year":"2017","journal-title":"Injury"},{"key":"R22-20260809","first-page":"e21.00045","article-title":"Preoperative anterior and posterior tilt of garden I-II femoral neck fractures predict treatment failure and need for reoperation in patients over 60 years","volume":"6","author":"Sj\u00f6holm","year":"2021","journal-title":"JB JS Open Access"},{"key":"R23-20260809","doi-asserted-by":"crossref","first-page":"252","DOI":"10.3109\/17453674.2016.1155253","article-title":"Preoperative posterior tilt of at least 20\u00b0 increased the risk of fixation failure in Garden-I and -II femoral neck fractures","volume":"87","author":"Dolatowski","year":"2016","journal-title":"Acta Orthop"},{"key":"R24-20260809","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.2106\/JBJS.18.01256","article-title":"Not all Garden-I and II femoral neck fractures in the elderly should be fixed: effect of posterior tilt on rates of subsequent arthroplasty","volume":"101","author":"Okike","year":"2019","journal-title":"J Bone Jt Surg Am"},{"key":"R25-20260809","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1080\/17453674.2019.1637469","article-title":"Posterior and anterior tilt increases the risk of failure after internal fixation of garden I and II femoral neck fracture","volume":"90","author":"Sj\u00f6holm","year":"2019","journal-title":"Acta Orthop"},{"key":"R26-20260809","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.1056\/NEJMoa1906190","article-title":"Total hip arthroplasty or hemiarthroplasty for hip fracture","volume":"381","author":"Bhandari","year":"2019","journal-title":"N Engl J Med"},{"issue":"suppl 3","key":"R27-20260809","doi-asserted-by":"crossref","first-page":"27","DOI":"10.2106\/JBJS.H.01574","article-title":"Survey design in orthopaedic surgery: getting surgeons to respond","volume":"91","author":"Sprague","year":"2009","journal-title":"The J bone Jt Surg. Am volume"},{"key":"R28-20260809","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1186\/s13018-017-0632-x","article-title":"Eight orthopedic surgeons achieved moderate to excellent reliability measuring the preoperative posterior tilt angle in 50 Garden-I and Garden-II femoral neck fractures","volume":"12","author":"Dolatowski","year":"2017","journal-title":"J Orthop Surg Res"},{"key":"R29-20260809","doi-asserted-by":"crossref","first-page":"2309499019836160","DOI":"10.1177\/2309499019836160","article-title":"The influence of the CT scan in the evaluation and treatment of nondisplaced femoral neck fractures in the elderly","volume":"27","author":"Zamora","year":"2019","journal-title":"J Orthop Surg"},{"key":"R30-20260809","doi-asserted-by":"crossref","first-page":"1854","DOI":"10.1080\/10255842.2021.1925256","article-title":"A three-dimensional measurement based on CT for the posterior tilt with ideal inter-and intra-observer reliability in non-displaced femoral neck fractures","volume":"24","author":"Wu","year":"2021","journal-title":"Computer Methods Biomechanics Biomed Eng"},{"key":"R31-20260809","doi-asserted-by":"crossref","first-page":"2078","DOI":"10.1001\/archinternmed.2009.427","article-title":"Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer","volume":"169","author":"Smith-Bindman","year":"2009","journal-title":"Arch Intern Med"},{"key":"R32-20260809","doi-asserted-by":"crossref","first-page":"87","DOI":"10.3928\/01477447-20101221-18","article-title":"The role of computed tomography in the diagnosis and management of femoral neck fractures in the geriatric patient","volume":"34","author":"Melvin","year":"2011","journal-title":"Orthopedics"},{"key":"R33-20260809","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1007\/s00590-004-0137-2","article-title":"The orthopaedic angle on angles: the accuracy of health care professionals in assessing angular displacement","volume":"14","author":"Molony","year":"2004","journal-title":"Eur J Orthop Surg Traumatology"},{"key":"R34-20260809","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.2106\/00004623-200309000-00004","article-title":"Internal fixation compared with arthroplasty for displaced fractures of the femoral neck: a meta-analysis","volume":"85","author":"Bhandari","year":"2003","journal-title":"J Bone Jt Surg"}],"container-title":["Journal of Orthopaedic Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/BOT.0000000000003186","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T18:00:19Z","timestamp":1786298419000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/BOT.0000000000003186"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":32,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/bot.0000000000003186","relation":{},"ISSN":["0890-5339","1531-2291"],"issn-type":[{"value":"0890-5339","type":"print"},{"value":"1531-2291","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-03-15","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}