{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:09:46Z","timestamp":1791976186431,"version":"4.4.0"},"reference-count":136,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T00:00:00Z","timestamp":1719446400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 \u201cmidas\u201d 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\u201329.49) and 44.8% (95% CI 39.38\u201351.4), 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.<\/jats:p>","DOI":"10.3390\/jcm13133769","type":"journal-article","created":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T11:19:02Z","timestamp":1719487142000},"page":"3769","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["An Umbrella Review and Updated Meta-Analysis of Imaging Modalities in Occult Scaphoid and Hip and Femoral Fractures"],"prefix":"10.3390","volume":"13","author":[{"given":"Patricia","family":"Jorisal","sequence":"first","affiliation":[{"name":"Abdominal Radiology, Department of Radiology, Faculty of Universitas Pelita Harapan, Tangerang 12930, Indonesia"},{"name":"Department of Radiology, Siloam Hospital Kebon Jeruk, Jakarta 11530, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Callistus Bruce Henfry","family":"Sulay","sequence":"additional","affiliation":[{"name":"Radiology Resident, Faculty of Universitas Pelita Harapan, Tangerang 12930, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6439-6265","authenticated-orcid":false,"given":"Gilbert Sterling","family":"Octavius","sequence":"additional","affiliation":[{"name":"Radiology Resident, Faculty of Universitas Pelita Harapan, Tangerang 12930, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.rcl.2007.04.008","article-title":"Occult Fractures of Extremities","volume":"45","author":"Ahn","year":"2007","journal-title":"Radiol. Clin. North Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1302\/0301-620X.94B8.28998","article-title":"Diagnostic accuracy of imaging modalities for suspected scaphoid fractures: Meta-analysis combined with latent class analysis","volume":"94","author":"Yin","year":"2012","journal-title":"J Bone Jt. Surg Br."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1007\/s11547-015-0561-x","article-title":"Errors and malpractice lawsuits in radiology: What the radiologist needs to know","volume":"120","author":"Frati","year":"2015","journal-title":"Radiol. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.injury.2009.08.017","article-title":"Clinical characteristics and long-term mortality of occult hip fracture elderly patients","volume":"41","author":"Beloosesky","year":"2010","journal-title":"Injury"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1111\/acem.13026","article-title":"Diagnostic Imaging Strategies for Occult Hip Fractures: A Decision and Cost-Effectiveness Analysis","volume":"23","author":"Yun","year":"2016","journal-title":"Acad. Emerg. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2309","DOI":"10.1097\/CORR.0000000000002851","article-title":"Routine MRI Among Patients with a Suspected Scaphoid Fracture Risks Overdiagnosis","volume":"481","author":"Bulstra","year":"2023","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bernstein, J. (2024). Letter to the Editor: Routine MRI Among Patients with a Suspected Scaphoid Fracture Risks Overdiagnosis. Clin. Orthop. Relat. Res.","DOI":"10.1097\/CORR.0000000000003050"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1016\/j.jacr.2019.02.029","article-title":"ACR Appropriateness Criteria\u00ae Acute Hand and Wrist Trauma","volume":"16","author":"Torabi","year":"2019","journal-title":"J. Am. Coll. Radiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S18","DOI":"10.1016\/j.jacr.2019.02.028","article-title":"ACR Appropriateness Criteria\u00ae Acute Hip Pain-Suspected Fracture","volume":"16","author":"Ross","year":"2019","journal-title":"J. Am. Coll. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan\u2014A web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s13643-021-01626-4","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"10","author":"Page","year":"2021","journal-title":"Syst. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"m2632","DOI":"10.1136\/bmj.m2632","article-title":"Preferred reporting items for systematic review and meta-analysis of diagnostic test accuracy studies (PRISMA-DTA): Explanation, elaboration, and checklist","volume":"370","author":"Salameh","year":"2020","journal-title":"BMJ"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1097\/XEB.0000000000000055","article-title":"Summarizing systematic reviews: Methodological development, conduct and reporting of an umbrella review approach","volume":"13","author":"Aromataris","year":"2015","journal-title":"Int. J. Evid. Based Healthc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1136\/ebmental-2018-300014","article-title":"Ten simple rules for conducting umbrella reviews","volume":"21","author":"Radua","year":"2018","journal-title":"Evid. Based Ment. Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3","DOI":"10.12997\/jla.2023.12.1.3","article-title":"Introduction to Umbrella Reviews as a Useful Evidence-Based Practice","volume":"12","author":"Choi","year":"2023","journal-title":"J. Lipid Atheroscler."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"j4008","DOI":"10.1136\/bmj.j4008","article-title":"AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both","volume":"358","author":"Shea","year":"2017","journal-title":"BMJ"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"529","DOI":"10.7326\/0003-4819-155-8-201110180-00009","article-title":"QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies","volume":"155","author":"Whiting","year":"2011","journal-title":"Ann. Intern. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1002\/jrsm.1557","article-title":"Graphical Representation of Overlap for OVErviews: GROOVE tool","volume":"13","author":"Bracchiglione","year":"2022","journal-title":"Res. Synth. Methods"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/2049-3258-72-39","article-title":"Metaprop: A Stata command to perform meta-analysis of binomial data","volume":"72","author":"Nyaga","year":"2014","journal-title":"Arch. Public Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jphys.2020.02.011","article-title":"Research Note: In a meta-analysis, the I(2) index does not tell us how much the effect size varies across studies","volume":"66","author":"Borenstein","year":"2020","journal-title":"J. Physiother."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Gao, J., Yang, L., Zhao, J., Wang, L., Zou, J., Wang, C., and Fan, X. (2020). Comparison of problem-based learning and traditional teaching methods in medical psychology education in China: A systematic review and meta-analysis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0243897"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V.A. (2019). Chapter 13: Assessing risk of bias due to missing results in a synthesis. Cochrane Handbook for Systematic Reviews of Interventions, John Wiley & Sons. [2nd ed.].","DOI":"10.1002\/9781119536604"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.2307\/2533446","article-title":"Operating characteristics of a rank correlation test for publication bias","volume":"50","author":"Begg","year":"1994","journal-title":"Biometrics"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/j.0006-341X.2000.00455.x","article-title":"Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis","volume":"56","author":"Duval","year":"2000","journal-title":"Biometrics"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V.A. (2019). Chapter 10: Analysing data and undertaking meta-analyses. Cochrane handbook for Systematic Reviews of Interventions, John Wiley & Sons. [2nd ed.].","DOI":"10.1002\/9781119536604"},{"key":"ref_27","unstructured":"MedCalc Software Ltd. (2023, December 29). Diagnostic Test Evaluation Calculator (Version 22.016). Available online: https:\/\/www.medcalc.org\/calc\/diagnostic_test.php."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1016\/j.jclinepi.2005.02.022","article-title":"Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews","volume":"58","author":"Reitsma","year":"2005","journal-title":"J. Clin. Epidemiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2865","DOI":"10.1002\/sim.942","article-title":"A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations","volume":"20","author":"Rutter","year":"2001","journal-title":"Stat. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4078\/jrd.2018.25.1.3","article-title":"Overview of the Process of Conducting Meta-analyses of the Diagnostic Test Accuracy","volume":"25","author":"Lee","year":"2018","journal-title":"J. Rheum. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1258\/096914103321610806","article-title":"A likelihood ratio approach to meta-analysis of diagnostic studies","volume":"10","author":"Stengel","year":"2003","journal-title":"J. Med. Screen."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3258","DOI":"10.1002\/sim.2812","article-title":"Prevalence-dependent diagnostic accuracy measures","volume":"26","author":"Li","year":"2007","journal-title":"Stat. Med."},{"key":"ref_34","first-page":"605","article-title":"MIDAS: Stata module for meta-analytical integration of diagnostic test accuracy studies","volume":"12","author":"Dwamena","year":"2007","journal-title":"Stata J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1177\/230949901101900123","article-title":"Review article: Magnetic resonance imaging and computed tomography in the diagnosis of occult proximal femur fractures","volume":"19","author":"Chatha","year":"2011","journal-title":"J. Orthop. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.2214\/AJR.19.21510","article-title":"Diagnostic Performance of CT for Occult Proximal Femoral Fractures: A Systematic Review and Meta-Analysis","volume":"213","author":"Kellock","year":"2019","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"559","DOI":"10.2214\/AJR.19.22676","article-title":"Diagnostic Accuracy of Limited MRI Protocols for Detecting Radiographically Occult Hip Fractures: A Systematic Review and Meta-Analysis","volume":"215","author":"Wilson","year":"2020","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1148\/radiol.2020192167","article-title":"Use of Advanced Imaging for Radiographically Occult Hip Fracture in Elderly Patients: A Systematic Review and Meta-Analysis","volume":"296","author":"Eng","year":"2020","journal-title":"Radiology"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Mallee, W.H., Wang, J., Poolman, R.W., Kloen, P., Maas, M., de Vet, H.C., and Doornberg, J.N. (2015). Computed tomography versus magnetic resonance imaging versus bone scintigraphy for clinically suspected scaphoid fractures in patients with negative plain radiographs. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD010023.pub2"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1007\/s00256-018-2931-7","article-title":"Ultrasound for diagnosing radiographically occult scaphoid fracture","volume":"47","author":"Kwee","year":"2018","journal-title":"Skelet. Radiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3610","DOI":"10.1007\/s00330-020-07604-z","article-title":"Dual-energy CT in the diagnosis of occult acute scaphoid injury: A direct comparison with MRI","volume":"31","author":"Xie","year":"2021","journal-title":"Eur. Radiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/S0020-1383(98)00115-6","article-title":"Imaging the problem scaphoid","volume":"29","author":"Kitsis","year":"1998","journal-title":"Injury"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1259\/0007-1285-69-818-109","article-title":"Clinically suspected scaphoid fracture: A comparison of magnetic resonance imaging and bone scintigraphy","volume":"69","author":"Thorpe","year":"1996","journal-title":"Br. J. Radiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1007\/s002560050459","article-title":"A comparison of bone scintigraphy and MRI in the early diagnosis of the occult scaphoid waist fracture","volume":"27","author":"Fowler","year":"1998","journal-title":"Skelet. Radiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/S0009-9260(05)81108-0","article-title":"Scaphoid fracture: A new method of assessment","volume":"48","author":"Hodgkinson","year":"1993","journal-title":"Clin. Radiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"241","DOI":"10.5505\/tjtes.2013.64927","article-title":"The role of bedside ultrasonography for occult scaphoid fractures in the emergency department","volume":"19","author":"Vandenberk","year":"2013","journal-title":"Ulus. Travma Acil. Cerrahi. Derg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1007\/s00256-010-1086-y","article-title":"Occult fractures of the scaphoid: The role of ultrasonography in the emergency department","volume":"40","author":"Platon","year":"2011","journal-title":"Skelet. Radiol."},{"key":"ref_48","first-page":"677","article-title":"Diagnosis of occult scaphoid fracture with high-spatial-resolution sonography: A prospective blind study","volume":"59","author":"Fusetti","year":"2005","journal-title":"J. Trauma"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/j.jhsa.2003.12.012","article-title":"Ultrasound for the early diagnosis of clinically suspected scaphoid fracture","volume":"29","author":"Senall","year":"2004","journal-title":"J. Hand Surg. Am."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.2214\/ajr.178.5.1781239","article-title":"Occult fractures of the waist of the scaphoid: Early diagnosis by high-spatial-resolution sonography","volume":"178","author":"Hauger","year":"2002","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1148\/radiology.220.1.r01jl15231","article-title":"Scaphoid fractures: Evaluation with high-spatial-resolution US initial results","volume":"220","author":"Herneth","year":"2001","journal-title":"Radiology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1097\/RLU.0b013e31826382cd","article-title":"Early CT compared with bone scintigraphy in suspected schapoid fractures","volume":"37","author":"Rhemrev","year":"2012","journal-title":"Clin. Nucl. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1007\/s11604-010-0520-3","article-title":"Diagnostic accuracy of multidetector computed tomography for patients with suspected scaphoid fractures and negative radiographic examinations","volume":"29","author":"Ilica","year":"2011","journal-title":"Jpn. J. Radiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"20","DOI":"10.2106\/JBJS.I.01523","article-title":"Comparison of CT and MRI for diagnosis of suspected scaphoid fractures","volume":"93","author":"Mallee","year":"2011","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1148\/radiol.2401050412","article-title":"Occult scaphoid fractures: Comparison of multidetector CT and MR imaging--initial experience","volume":"240","author":"Memarsadeghi","year":"2006","journal-title":"Radiology"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1302\/0301-620X.90B9.20341","article-title":"Early magnetic resonance imaging compared with bone scintigraphy in suspected scaphoid fractures","volume":"90","author":"Beeres","year":"2008","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1148\/radiology.203.1.9122402","article-title":"Radiographically occult scaphoid fractures: Value of MR imaging in detection","volume":"203","author":"Breitenseher","year":"1997","journal-title":"Radiology"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1007\/BF01084373","article-title":"Magnetic resonance imaging versus bone scintigraphy in suspected scaphoid fracture","volume":"23","author":"Roolker","year":"1996","journal-title":"Eur. J. Nucl. Med."},{"key":"ref_59","first-page":"61","article-title":"Radiography and scintigraphy of suspected scaphoid fracture. A long-term study in 160 patients","volume":"75","author":"Broekhuizen","year":"1993","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0266-7681(84)80027-3","article-title":"Bone scanning of fractures of the scaphoid","volume":"9","author":"Stordahl","year":"1984","journal-title":"J. Hand Surg. Br."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/BF02940182","article-title":"Radiography and scintigraphy in the diagnosis of carpal scaphoid fractures","volume":"151","author":"Doyle","year":"1982","journal-title":"Ir. J. Med. Sci."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"303","DOI":"10.3109\/17453678308996574","article-title":"Bone scintigraphy in the evaluation of fracture of the carpal scaphoid bone","volume":"54","author":"Nielsen","year":"1983","journal-title":"Acta Orthop. Scand."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.ejrad.2017.10.010","article-title":"Diagnostic value of cone beam computed tomography (CBCT) in occult scaphoid and wrist fractures","volume":"97","author":"Borel","year":"2017","journal-title":"Eur. J. Radiol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s00256-015-2290-6","article-title":"Cone-Beam CT in diagnosis of scaphoid fractures","volume":"45","author":"Edlund","year":"2016","journal-title":"Skelet. Radiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1007\/s00330-019-06387-2","article-title":"Value of CT to detect radiographically occult injuries of the proximal femur in elderly patients after low-energy trauma: Determination of non-inferiority margins of CT in comparison with MRI","volume":"30","author":"Lanotte","year":"2020","journal-title":"Eur. Radiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s10140-020-01834-w","article-title":"Negative predictive value of CT for occult fractures of the hip and pelvis with imaging follow-up","volume":"28","author":"Haims","year":"2021","journal-title":"Emerg Radiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"102087","DOI":"10.1016\/j.jcot.2022.102087","article-title":"Diagnostic accuracy of ultrasonography for occult femoral neck fracture","volume":"36","author":"Tsukamoto","year":"2023","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1111\/1742-6723.13524","article-title":"Use of computed tomography and magnetic resonance imaging for occult neck of femur fractures: A single-centre study","volume":"32","author":"Kutaiba","year":"2020","journal-title":"Emerg. Med. Australas."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s10140-014-1249-6","article-title":"Detection of occult, undisplaced hip fractures with a dual-energy CT algorithm targeted to detection of bone marrow edema","volume":"22","author":"Reddy","year":"2015","journal-title":"Emerg. Radiol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"3932","DOI":"10.1007\/s00330-015-4189-y","article-title":"Computed tomography compared to magnetic resonance imaging in occult or suspect hip fractures. A retrospective study in 44 patients","volume":"26","author":"Collin","year":"2016","journal-title":"Eur. Radiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s10140-016-1385-2","article-title":"Added value of interpreter experience in occult and suspect hip fractures: A retrospective analysis of 254 patients","volume":"23","author":"Collin","year":"2016","journal-title":"Emerg. Radiol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s10140-015-1350-5","article-title":"Prevalence of exclusively and concomitant pelvic fractures at magnetic resonance imaging of suspect and occult hip fractures","volume":"23","author":"Collin","year":"2016","journal-title":"Emerg. Radiol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.7863\/jum.2009.28.11.1447","article-title":"Posttraumatic painful hip: Sonography as a screening test for occult hip fractures","volume":"28","author":"Safran","year":"2009","journal-title":"J. Ultrasound Med."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s002560050365","article-title":"Magnetic resonance imaging: A cost-effective alternative to bone scintigraphy in the evaluation of patients with suspected hip fractures","volume":"27","author":"Rubin","year":"1998","journal-title":"Skelet. Radiol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1302\/0301-620X.76B1.8300666","article-title":"Comparison of MRI with bone scanning for suspected hip fracture in elderly patients","volume":"76","author":"Evans","year":"1994","journal-title":"J. Bone Jt. Surg Br."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"395","DOI":"10.2106\/00004623-199303000-00011","article-title":"Diagnosis of occult fractures about the hip. Magnetic resonance imaging compared with bone-scanning","volume":"75","author":"Rizzo","year":"1993","journal-title":"JBJS"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"830319","DOI":"10.1155\/2013\/830319","article-title":"Investigation of occult hip fractures: The use of CT and MRI","volume":"2013","author":"Gill","year":"2013","journal-title":"Sci. World J."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1016\/j.injury.2016.02.020","article-title":"Imaging of occult hip fractures: CT or MRI?","volume":"47","author":"Rehman","year":"2016","journal-title":"Injury"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1258\/ar.2011.110466","article-title":"Bone bruise, lipohemarthrosis, and joint effusion in CT of non-displaced hip fracture","volume":"53","author":"Geijer","year":"2012","journal-title":"Acta Radiol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s10140-011-1009-9","article-title":"High clinical utility of computed tomography compared to radiography in elderly patients with occult hip fracture after low-energy trauma","volume":"19","author":"Dunker","year":"2012","journal-title":"Emerg. Radiol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1308\/003588414X13824511650533","article-title":"The use of computed tomography in identifying radiologically occult hip fractures in the elderly","volume":"96","author":"Heikal","year":"2014","journal-title":"Ann. R Coll. Surg. Engl."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1016\/j.injury.2015.05.006","article-title":"Sensitivity and specificity of CT- and MRI-scanning in evaluation of occult fracture of the proximal femur","volume":"46","author":"Haubro","year":"2015","journal-title":"Injury"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s13017-015-0049-y","article-title":"Occult fractures of the proximal femur: Imaging diagnosis and management of 82 cases in a regional trauma center","volume":"10","author":"Deleanu","year":"2015","journal-title":"World J. Emerg. Surg."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"2769","DOI":"10.1016\/j.injury.2016.10.019","article-title":"The sensitivity of ct scans in diagnosing occult femoral neck fractures","volume":"47","author":"Sadozai","year":"2016","journal-title":"Injury"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"20150250","DOI":"10.1259\/bjr.20150250","article-title":"The validity of investigating occult hip fractures using multidetector CT","volume":"89","author":"Thomas","year":"2016","journal-title":"Br. J. Radiol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/s10140-018-1580-4","article-title":"Computed tomography for occult fractures of the proximal femur, pelvis, and sacrum in clinical practice: Single institution, dual-site experience","volume":"25","author":"Mandell","year":"2018","journal-title":"Emerg. Radiol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.diii.2018.11.008","article-title":"MRI detection of radiographically occult fractures of the hip and pelvis in the elderly: Comparison of T2-weighted Dixon sequence with T1-weighted and STIR sequences","volume":"100","author":"Heynen","year":"2019","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/j.injury.2005.01.024","article-title":"Early diagnosis of occult hip fractures MRI versus CT scan","volume":"36","author":"Lubovsky","year":"2005","journal-title":"Injury"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1148\/radiology.170.1.2909083","article-title":"Occult fractures of the proximal femur: MR imaging","volume":"170","author":"Deutsch","year":"1989","journal-title":"Radiology"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1148\/radiology.187.2.8475292","article-title":"Prospective evaluation of patients with suspected hip fracture and indeterminate radiographs: Use of T1-weighted MR images","volume":"187","author":"Quinn","year":"1993","journal-title":"Radiology"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/BF00203696","article-title":"Magnetic resonance imaging of occult fractures of the proximal femur","volume":"23","author":"Haramati","year":"1994","journal-title":"Skelet. Radiol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1148\/radiology.197.1.7568834","article-title":"MR imaging in evaluation of suspected hip fracture: Frequency of unsuspected bone and soft-tissue injury","volume":"197","author":"Bogost","year":"1995","journal-title":"Radiology"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1080\/02841859709172425","article-title":"MR findings in cases of suspected impacted fracture of the femoral neck","volume":"38","author":"Stiris","year":"1997","journal-title":"Acta. Radiol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S0020-1383(97)00165-4","article-title":"The role of MRI in the diagnosis of occult hip fractures","volume":"29","author":"Pandey","year":"1998","journal-title":"Injury"},{"key":"ref_95","first-page":"607","article-title":"Limited magnetic resonance imaging (MRI) and the occult hip fracture","volume":"31","author":"Lim","year":"2002","journal-title":"Ann. Acad. Med. Singap."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"283","DOI":"10.2214\/ajr.182.2.1820283","article-title":"Prevalence and patterns of occult hip fractures and mimics revealed by MRI","volume":"182","author":"Oka","year":"2004","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/j.1440-1673.2004.01236.x","article-title":"Patterns of injury in patients with radiographic occult fracture of neck of femur as determined by magnetic resonance imaging","volume":"48","author":"Galloway","year":"2004","journal-title":"Australas. Radiol."},{"key":"ref_98","first-page":"271","article-title":"Early magnetic resonance imaging of radiographically occult osteoporotic fractures of the femoral neck","volume":"10","author":"Lee","year":"2004","journal-title":"Hong Kong Med. J."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1302\/0301-620X.87B9.16558","article-title":"The MRI diagnosis and management of incomplete intertrochanteric fractures of the femur","volume":"87","author":"Alam","year":"2005","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1080\/17453670510041510","article-title":"MRI diagnosis of occult hip fractures","volume":"76","author":"Frihagen","year":"2005","journal-title":"Acta Orthop."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s00330-004-2421-2","article-title":"The advantages of MRI in the detection of occult hip fractures","volume":"15","author":"Verbeeten","year":"2005","journal-title":"Eur. Radiol."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1197\/j.aem.2004.10.024","article-title":"Prevalence of traumatic hip and pelvic fractures in patients with suspected hip fracture and negative initial standard radiographs--a study of emergency department patients","volume":"12","author":"Dominguez","year":"2005","journal-title":"Acad. Emerg. Med."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.injury.2005.07.012","article-title":"The role of MRI in the diagnosis of proximal femoral fractures in the elderly","volume":"37","author":"Chana","year":"2006","journal-title":"Injury"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/j.injury.2007.04.023","article-title":"Is magnetic resonance imaging (MRI) necessary to exclude occult hip fracture?","volume":"38","author":"Hossain","year":"2007","journal-title":"Injury"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1302\/0301-620X.91B8.21959","article-title":"The use of MRI to detect occult fractures of the proximal femur: A study of 102 consecutive cases over a ten-year period","volume":"91","author":"Sankey","year":"2009","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1007\/s00256-012-1362-0","article-title":"Radiographically occult femoral and pelvic fractures are not mutually exclusive: A review of fractures detected by MRI following low-energy trauma","volume":"41","author":"Thomas","year":"2012","journal-title":"Skelet. Radiol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1302\/0301-620X.94B7.28693","article-title":"The value of T1-weighted coronal MRI scans in diagnosing occult fracture of the hip","volume":"94","author":"Iwata","year":"2012","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s00402-011-1388-0","article-title":"Occult hip and pelvic fractures and accompanying muscle injuries around the hip","volume":"132","author":"Ohishi","year":"2012","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1302\/0301-620X.89B10.19539","article-title":"Are occult fractures of the hip and pelvic ring mutually exclusive?","volume":"89","author":"Lakshmanan","year":"2007","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_110","unstructured":"Lord, C., Leach, S., and Skiadas, V.T. (2017). MRI for suspected hip fracture: How many sequences are enough?. ESSR, 2017."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s00256-018-3004-7","article-title":"Diagnostic accuracy of an abbreviated MRI protocol for detecting radiographically occult hip and pelvis fractures in the elderly","volume":"48","author":"Ross","year":"2019","journal-title":"Skelet. Radiol."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.clinimag.2018.06.014","article-title":"Radiographic analysis of anatomic risk factors for scaphoid fractures; A case-control study","volume":"51","author":"Turan","year":"2018","journal-title":"Clin. Imaging"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1007\/s00198-015-3390-9","article-title":"Risk factors for hip fracture in very old people: A population-based study","volume":"27","author":"Wiklund","year":"2016","journal-title":"Osteoporos. Int."},{"key":"ref_114","first-page":"137","article-title":"The risk factors for mortality in elderly patients with hip fractures: Postoperative one-year results","volume":"51","author":"Ozkan","year":"2010","journal-title":"Singap. Med. J."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1055\/s-0040-1720963","article-title":"Incidence of Scaphoid Fractures and Associated Injuries at US Trauma Centers","volume":"10","author":"Wells","year":"2021","journal-title":"J. Wrist Surg."},{"key":"ref_116","doi-asserted-by":"crossref","unstructured":"Trevethan, R. (2017). Sensitivity, Specificity, and Predictive Values: Foundations, Pliabilities, and Pitfalls in Research and Practice. Front. Public Health, 5.","DOI":"10.3389\/fpubh.2017.00307"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"S56","DOI":"10.1007\/s11606-012-2029-1","article-title":"Chapter 8: Meta-analysis of test performance when there is a \u201cgold standard\u201d","volume":"27","author":"Trikalinos","year":"2012","journal-title":"J. Gen. Intern. Med."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.jclinepi.2008.04.007","article-title":"Diagnostic test accuracy may vary with prevalence: Implications for evidence-based diagnosis","volume":"62","author":"Leeflang","year":"2009","journal-title":"J. Clin. Epidemiol."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1373\/clinchem.2003.024752","article-title":"Test research versus diagnostic research","volume":"50","author":"Moons","year":"2004","journal-title":"Clin. Chem."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.radi.2020.09.014","article-title":"Has NICE guidance changed the management of the suspected scaphoid fracture: A survey of UK practice","volume":"27","author":"Snaith","year":"2021","journal-title":"Radiography"},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.2214\/ajr.177.6.1771257","article-title":"Cost-effectiveness of immediate MR imaging versus traditional follow-up for revealing radiographically occult scaphoid fractures","volume":"177","author":"Dorsay","year":"2001","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1302\/0301-620X.101B8.BJJ-2018-1590.R1","article-title":"Clinical and cost implications of using immediate MRI in the management of patients with a suspected scaphoid fracture and negative radiographs results from the SMaRT trial","volume":"101","author":"Rua","year":"2019","journal-title":"Bone Jt. J."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1016\/j.jval.2020.05.020","article-title":"Cost-Effectiveness of Immediate Magnetic Resonance Imaging In the Management of Patients With Suspected Scaphoid Fracture: Results From a Randomized Clinical Trial","volume":"23","author":"Rua","year":"2020","journal-title":"Value Health."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.2214\/AJR.05.0686","article-title":"An international survey of hospital practice in the imaging of acute scaphoid trauma","volume":"187","author":"Groves","year":"2006","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"100358","DOI":"10.1016\/j.ejro.2021.100358","article-title":"What is the role of ultrasonography in the early diagnosis of scaphoid fractures?","volume":"8","author":"Ortiz","year":"2021","journal-title":"Eur. J. Radiol. Open."},{"key":"ref_126","doi-asserted-by":"crossref","unstructured":"Muljadi, R., and Koesbandono Octavius, G.S. (2024). A systematic review and meta-analysis of diagnostic test accuracy of chest ultrasound in diagnosing pediatric pulmonary tuberculosis. Pediatr. Pulmonol.","DOI":"10.1002\/ppul.27044"},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.mporth.2022.06.001","article-title":"Cone-beam computed tomography in orthopaedics","volume":"36","author":"Bailey","year":"2022","journal-title":"Orthop. Trauma"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.surge.2016.10.004","article-title":"Tomosynthesis: A new radiologic technique for rapid diagnosis of scaphoid fractures","volume":"16","author":"Compton","year":"2018","journal-title":"Surgeon"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"102834","DOI":"10.1016\/j.otsr.2021.102834","article-title":"Impact of introducing extremity cone-beam CT in an emergency radiology department: A population-based study","volume":"107","author":"Jacques","year":"2021","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/j.radi.2022.01.009","article-title":"Comparison of scattered entrance skin dose burden in MSCT, CBCT, and X-ray for suspected scaphoid injury: Regional dose measurements in a phantom model","volume":"28","author":"Hughes","year":"2022","journal-title":"Radiography"},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"518","DOI":"10.3109\/17453674.2014.925353","article-title":"Prevalence and clinical significance of occult fractures in children with radiograph-negative acute ankle injury. A meta-analysis","volume":"85","author":"Nectoux","year":"2014","journal-title":"Acta Orthop."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"2303","DOI":"10.1097\/CORR.0000000000002914","article-title":"Editor\u2019s Spotlight\/Take 5: Routine MRI Among Patients With a Suspected Scaphoid Fracture Risks Overdiagnosis","volume":"481","author":"Leopold","year":"2023","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_133","first-page":"370169","article-title":"Radiographically occult and subtle fractures: A pictorial review","volume":"2013","author":"Jarraya","year":"2013","journal-title":"Radiol. Res. Pract."},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s00256-003-0711-4","article-title":"FDG-PET uptake in occult acute pelvic fracture","volume":"33","author":"Ravenel","year":"2004","journal-title":"Skelet. Radiol."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"W245","DOI":"10.2214\/AJR.17.18523","article-title":"Clinical Nononcologic Applications of PET\/CT and PET\/MRI in Musculoskeletal, Orthopedic, and Rheumatologic Imaging","volume":"210","author":"Gholamrezanezhad","year":"2018","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"e246","DOI":"10.1097\/RLU.0b013e318263819e","article-title":"Use of hybrid SPECT\/CT for diagnosis of radiographic occult fractures of the wrist","volume":"38","author":"Allainmat","year":"2013","journal-title":"Clin. Nucl. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/13\/3769\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:06:25Z","timestamp":1760108785000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/13\/3769"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,27]]},"references-count":136,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["jcm13133769"],"URL":"https:\/\/doi.org\/10.3390\/jcm13133769","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,27]]}}}