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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302(14):1573-1579. Review/Other-Dx 109,805 respondents, 786,717 hip fractures To examine trends in hip fracture incidence and resulting mortality over 20 years in the U.S. Medicare population. Between 1986 and 2005, the annual mean number of hip fractures was 957.3 per 100,000 (95% CI, 921.7-992.9) for women and 414.4 per 100,000 (95% CI, 401.6-427.3) for men. The age-adjusted incidence of hip fracture increased from 1986 to 1995 and then steadily declined from 1995 to 2005. In women, incidence increased 9.0%, from 964.2 per 100,000 (95% CI, 958.3-970.1) in 1986 to 1050.9 (95% CI, 1045.2-1056.7) in 1995, with a subsequent decline of 24.5% to 793.5 (95% CI, 788.7-798.3) in 2005. In men, the increase in incidence from 1986 to 1995 was 16.4%, from 392.4 (95% CI, 387.8-397.0) to 456.6 (95% CI, 452.0-461.3), and the subsequent decrease to 2005 was 19.2%, to 369.0 (95% CI, 365.1-372.8). Age- and risk-adjusted mortality in women declined by 11.9%, 14.9%, and 8.8% for 30-, 180-, and 360-day mortality, respectively. For men, age- and risk-adjusted mortality decreased by 21.8%, 25.4%, and 20.0% for 30-, 180-, and 360-day mortality, respectively. Over time, patients with hip fracture have had an increase in all comorbidities recorded except paralysis. The incidence decrease is coincident with increased use of bisphosphonates. 4
2. Kani KK, Porrino JA, Mulcahy H, Chew FS. Fragility fractures of the proximal femur: review and update for radiologists. [Review]. Skeletal Radiology. 48(1):29-45, 2019 Jan. Review/Other-Dx N/A To review relevant proximal femoral anatomy together with imaging, classification, and management of proximal femoral fragility fractures, and their most common complications. No results stated in abstract. 4
3. Khan SK, Kalra S, Khanna A, Thiruvengada MM, Parker MJ. Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291,413 patients. Injury. 2009;40(7):692-697. Review/Other-Dx 52 studies involving 291,413 patients To review previous published studies on hip fractures with the aim of developing a consensus from the literature for the optimum timing for surgery for an acute hip fracture. Delaying surgery may not affect mortality but it is likely to increase morbidity, specifically the incidence of pressure sores and hospital stay. Delaying surgery will prolong distress from this type of injury, therefore, patients admitted to a hospital with a hip fracture, where there are no specific conditions that can be improved prior to surgery, should have their operation as soon as possible after admission (within 48 hours) to a hospital. 4
4. Lefaivre KA, Macadam SA, Davidson DJ, Gandhi R, Chan H, Broekhuyse HM. Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br. 2009;91(7):922-927. Observational-Dx 607 patients To determine the effect of delay to surgery on the time to discharge, in-hospital death, the presence of major and minor medical complications and the incidence of pressure sores in patients with a fracture of the hip. Delay to surgery (P=0.0255), comorbidity (P<0.0001), age (P<0.0001) and type of fracture (P=0.0004) were all significant in the Cox proportional hazards model for increased time to discharge. Delay to surgery was not a significant predictor of in-hospital mortality. However, a delay of more than 24 hours was a significant predictor of a minor medical complication (OR 1.53, 95% CI, 1.05 to 2.22), while a delay of more than 48 hours was associated with an increased risk of a major medical complication (OR 2.21, 95% CI, 1.01 to 4.34), a minor medical complication (OR 2.27, 95% CI, 1.38 to 3.72) and of pressure sores (OR 2.29, 95% CI, 1.19 to 4.40). Patients with a fracture of the hip should have surgery early to lessen the time to acute-care hospital discharge and to minimize the risk of complications. 4
5. Bretherton CP, Parker MJ. Early surgery for patients with a fracture of the hip decreases 30-day mortality. Bone Joint J. 97-B(1):104-8, 2015 Jan. Observational-Tx 6236 patients To determine if early surgery confers an additional survival benefit at 30 days after correcting for a range of potentially confounding patient factors. In all, 6638 patients aged > 60 years were included. Worsening American Society of Anaesthesiologists grade (p < 0.001), increased age (p < 0.001) and extracapsular fracture (p < 0.019) increased the risk of 30-day mortality. Increasing mobility score (p = 0.014), mini mental test score (p < 0.001) and female gender (p = 0.014) improved survival. After adjusting for these confounders, surgery before 12 hours improved survival compared with surgery after 12 hours (p = 0.013). Beyond this the increasing delay to surgery did not significantly affect the 30-day mortality. 1
6. Nyholm AM, Gromov K, Palm H, et al. Time to Surgery Is Associated with Thirty-Day and Ninety-Day Mortality After Proximal Femoral Fracture: A Retrospective Observational Study on Prospectively Collected Data from the Danish Fracture Database Collaborators. J Bone Joint Surg Am. 97(16):1333-9, 2015 Aug 19. Observational-Tx 3517 surgeries To evaluate the association between surgical delay and early mortality in proximal femoral fracture patients. For the 3517 surgeries included in this study, the median patient age was 82.0 years (range, fifty-one to 107 years), 2458 patients (70%) were female, and 1720 surgeries (49%) were performed because of a trochanteric fracture. Within twelve hours, 722 of the surgeries (21%) had been performed; within twenty-four hours, 2482 surgeries (71%); within thirty-six hours, 3024 surgeries (86%); within forty-eight hours, 3242 surgeries (92%); and within seventy-two hours, 3353 surgeries (95%). Unsupervised surgeons with an education level below that of an attending surgeon performed the surgery in 1807 (51%) of all cases. The thirty-day mortality was 380 (10.8%) and the ninety-day mortality was 612 (17.4%). The risk of thirty-day mortality increased with a surgical delay of more than twelve hours (odds ratio, 1.45; p = 0.02), more than twenty-four hours (odds ratio, 1.34; p = 0.02), and more than forty-eight hours (odds ratio, 1.56; p = 0.02); the risk of ninety-day mortality increased with a surgical delay of more than twenty-four hours (odds ratio, 1.23; p = 0.04). An education level of the surgeon below that of an attending surgeon increased the risk of thirty-day mortality (odds ratio, 1.28; p = 0.035) and ninety-day mortality (odds ratio, 1.26; p = 0.016). Increasing American Society of Anesthesiologists score and male sex significantly increased both thirty-day and ninety-day mortality. 2
7. Bartolotta RJ, Belfi LM, Ha AS. Breaking Down Fractures of the Pelvis and Hip. Semin Roentgenol 2021;56:39-46. Review/Other-Dx N/A To examine classification systems for fractures of the pelvic ring, acetabulum, and hip with attention to current treatment algorithms and management implications. No results stated in abstract. 4
8. Mandell JC, Marshall RA, Weaver MJ, Harris MB, Sodickson AD, Khurana B. Traumatic Hip Dislocation: What the Orthopedic Surgeon Wants to Know. [Review]. Radiographics. 37(7):2181-2201, 2017 Nov-Dec. Review/Other-Dx N/A To review the anatomy of the hip, common injury mechanisms for various types of dislocations, and imaging findings for associated injuries. No results stated in abstract. 4
9. Walker MR, El Naga AN, Atassi OH, Perkins CH, Mitchell SA. Effect of initial emergency room imaging choice on time to hip reduction and repeat imaging. Injury. 50(3):686-689, 2019 Mar. Observational-Dx 88 patients To investigate the relationship between choice of pre-reduction imaging and treatment of acute hip dislocations. Group I included 29 patients and Group II included 59 patients. The mean time to reduction was 74 min in Group I and 129 min in Group II for a difference of 55 min (p < 0.001). The rate of repeat CT scan was 0 in Group I versus 48 (81%) in Group II (p < 0.001). 3
10. Weissman BN, Palestro CJ, Fox MG, et al. ACR Appropriateness Criteria® Imaging After Total Hip Arthroplasty. J Am Coll Radiol 2023;20:S413-S32. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for imaging after total hip arthroplasty. No results stated in abstract. 4
11. Jawetz ST, Fox MG, Blankenbaker DG, et al. ACR Appropriateness Criteria® Chronic Hip Pain: 2022 Update. J Am Coll Radiol 2023;20:S33-S48. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for chronic hip pain. No results stated in abstract. 4
12. American College of Radiology. ACR Appropriateness Criteria®: Stress (Fatigue-Insufficiency) Fracture Including Sacrum Excluding Other Vertebrae. Available at: https://acsearch.acr.org/docs/69435/Narrative/ Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. No abstract available. 4
13. Pierce JL, Perry MT, Wessell DE, et al. ACR Appropriateness Criteria® Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot): 2022 Update. J Am Coll Radiol 2022;19:S473-S87. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot). No results stated in abstract. 4
14. Stephenson JW, Davis KW. Imaging of traumatic injuries to the hip. [Review]. Semin Musculoskelet Radiol. 17(3):306-15, 2013 Jul. Review/Other-Dx N/A To review the imaging techniques of traumatic injuries to the hip. No results stated in abstract. 4
15. Harding J, Chesser TJ, Bradley M. The Bristol hip view: its role in the diagnosis and surgical planning and occult fracture diagnosis for proximal femoral fractures. ScientificWorldJournal. 2013:703783, 2013. Observational-Dx 166 patients To evaluate whether a modified radiographic view of the femoral neck improves the diagnosis of occult proximal femoral. 166 consecutive patients presenting with the clinical diagnosis of a proximal femoral fracture, of which 61 sustained a fracture. Six of these were deemed occult due to negative plain and had proven fractures on subsequent cross-sectional imaging. The Bristol hip view demonstrated five of these six fractures. It performed better than the traditional lateral hip view to identify the injury. The Bristol hip view predicted correctly the fracture type and displacement in all cases and missed only one of the occult fractures. 2
16. Khurana B, Mandell JC, Rocha TC, et al. Internal Rotation Traction Radiograph Improves Proximal Femoral Fracture Classification Accuracy and Agreement. AJR. American Journal of Roentgenology. 211(2):409-415, 2018 08. Observational-Dx 78 patients To assess the clinical utility of internal rotation traction radiography in the classification of proximal femoral fractures. With the traction view, the pooled accuracy increased from 44.9% to 72.4%, subjective confidence increased from 87% to 94%, and confidence-weighted accuracy increased from 51.7% to 74.3% (p < 0.001). With the traction view, the kappa statistic for agreement with the reference standard increased from 0.530 to 0.791 and from 0.381 to 0.625 for the two readers, and interreader agreement increased from 0.480 to 0.678 (p < 0.001). 2
17. Garcia-Serrano MC, Garcia-Guerrero LF, Gomez-Gelvez A, Pinzon-Rendon AA. Diagnostic imaging concordance study: Are traction radiographs necessary in a hip fracture?. Injury. 52(6):1445-1449, 2021 Jun. Review/Other-Dx 64 patients To evaluate the clinical use of internal rotation and traction radiograph in the classification of proximal femur fractures. 82.8% presented a secondary fracture from falling from their own height. As the observer's experience increases, the need for traction radiograph decreases; interobserver kappa goes from 0.98 in experts to 0.01 in students. Traction radiograph is important in the diagnosis of potentially unstable fractures. Of the 1,503 radiographs with traction, 636 (42.38%) were classified as potentially unstable. And of the 708 without traction, 560 (79.1%) were classified as potentially unstable. 4
18. Alabousi M, Gauthier ID, Li N, et al. Multi-detector CT for suspected hip fragility fractures: A diagnostic test accuracy systematic review and meta-analysis. Emergency Radiology. 26(5):549-556, 2019 Oct. Meta-analysis Four studies reporting on 418 patients (174 with hip fractures) were included. To perform a systematic review (SR) and meta-analysis to determine the diagnostic test accuracy (DTA) of Multi-Detector Computed Tomography (MDCT) for detecting proximal femoral (hip) fragility fractures in patients with a negative initial radiograph. Pooled summary statistics included the following: sensitivity (87%; 95% confidence interval [CI] 79-93), specificity (98%; 95% CI 95-99), and the area under the summary receiver operating characteristic (ROC) curve (0.972). MDCT has a high specificity for detecting hip fragility fractures, comparable to MRI, but a lower sensitivity. Local institutional factors may play a role in whether a patient receives MDCT or MRI, as imaging should not be delayed. If there is ongoing concern for fracture in a patient with a negative MDCT, MRI should be performed. Cautious interpretation of the results is warranted given the risk of bias and small sample size. Inadequate
19. Davidson A, Silver N, Cohen D, et al. Justifying CT prior to MRI in cases of suspected occult hip fracture. A proposed diagnostic protocol. Injury. 52(6):1429-1433, 2021 Jun. Review/Other-Dx 103 patients To investigate a protocol that balances these issues providing a practical and cost-effective solution. In 50 patients (49%) hip fracture was diagnosed by CT alone. In the remaining 53 patients (51%) no definitive diagnosis was reached by CT and MRI was subsequently performed. 12 of these 53 patients (23%) were diagnosed with hip fracture necessitating surgery. In the CT only group mean time from admission to diagnosis was 3 hours, in the CT + MRI group this rose to 40 hours. Cost analysis showed that this protocol was more cost-effective than performing MRI in all patients, saving an estimated 66,805 Euro during the study period. 4
20. Haj-Mirzaian A, Eng J, Khorasani R, et al. Use of Advanced Imaging for Radiographically Occult Hip Fracture in Elderly Patients: A Systematic Review and Meta-Analysis. Radiology. 296(3):521-531, 2020 09. Meta-analysis Thirty-five studies including 2992 patients. To estimate the frequency of radiographically occult hip fracture in elderly patients, to define the higher-risk subpopulation, and to determine the diagnostic performance of CT and bone scanning in the detection of occult fractures by using MRI as the reference standard. Thirty-five studies were identified (2992 patients; mean age, 76.8 years ± 6.0 [standard deviation]; 66% female). The frequency of radiographically occult surgical hip fracture was 39% (1110 of 2835 patients; 95% confidence interval [CI]: 35%, 43%) in studies of patients with no definite radiographic fracture and 92% (134 of 157 patients; 95% CI: 83%, 98%) in studies of patients with radiographic evidence of isolated GT fracture (moderate SOE). The frequency of occult fracture was higher in patients aged at least 80 years (44%, 529 of 1184), those with an equivocal radiographic report (58%, 71 of 126), and those with a history of trauma (41%, 977 of 2370) (moderate SOE). CT and bone scanning yielded comparable diagnostic performance in the detection of radiographically occult hip fracture (P = .67), with a sensitivity of 79% and 87%, respectively (low SOE). Good
21. Kellock TT, Khurana B, Mandell JC. Diagnostic Performance of CT for Occult Proximal Femoral Fractures: A Systematic Review and Meta-Analysis. AJR. American Journal of Roentgenology. 213(6):1324-1330, 2019 12. Meta-analysis 13 studies (1248 patients) To assess the diagnostic performance of CT for detection of occult proximal femoral fracture. Thirteen heterogeneously reported studies were assessed that included 1248 patients (496 with a hip fracture and 752 without) with MRI or clinical follow-up as the reference standard. There were 50 false-negative examinations. The summary estimate of sensitivity was 94% and of specificity was 100%. Good
22. Lanotte SJ, Larbi A, Michoux N, et al. 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. European Radiology. 30(2):1113-1126, 2020 Feb. Observational-Dx 102 study participants with post-traumatic femoral injury To determine the margins of non-inferiority of the sensitivity of CT and the sample size needed to test the non-inferiority of CT in comparison with MRI. Twenty-nine out of 102 study participants had a post-traumatic femoral injury. SeCT ranged between 83 and 93% and SeMRI ranged between 97 and 100%. The 95% CIs for (SeCT-SeMRI) were [- 5.3%, + 0.8%], (pR1 = 0.1250), [- 4.5%; + 1.2%] (pR2 = 0.2188), [- 3.4%; + 1.1%] (pR3 = 0.2500) to [- 3.8%; + 1.6%] (pR4 = 0.3750) according to readers, with a lowest limit for 95% CIs superior to a non-inferiority margin of (- 6%) for all readers. A population of 440 patients should be analyzed to test the non-inferiority of CT in comparison with MRI. 1
23. Foex BA, Russell A. BET 2: CT versus MRI for occult hip fractures. [Review]. Emergency Medicine Journal. 35(10):645-647, 2018 Oct. Review/Other-Dx N/A To establish whether CT or MRI is better at detecting an occult hip fracture. No results stated in abstract. 4
24. Haims AH, Wang A, Yoo BJ, Porrino J. Negative predictive value of CT for occult fractures of the hip and pelvis with imaging follow-up. Emergency Radiology. 28(2):259-264, 2021 Apr. Review/Other-Dx 81 patients To determine the negative predictive value of multidetector CT for radiographically occult fracture of the hip or pelvis in an elderly population presenting to the emergency department. There were 39 cases with follow-up imaging performed within 6 weeks of the negative index CT, and 42 with follow-up imaging within 6 weeks to 18 months of the negative index CT. Eight of 81 patients demonstrated a fracture on follow-up imaging, with 3 of 8 involving the femoral neck or intertrochanteric femur. The negative predictive value of the index CT for the detection of a radiographically occult hip or pelvic fracture was 90.1%. If considering only surgically relevant fractures (femoral neck and intertrochanteric fractures), the negative predictive value improved to 96.3%. 4
25. Gatt T, Cutajar D, Borg L, Giordmaina R. The Necessity of CT Hip Scans in the Investigation of Occult Hip Fractures and Their Effect on Patient Management. Advances in Orthopaedics. 2021:8118147, 2021. Observational-Dx 447 suspected occult hip fractures. To assess the frequency at which computed tomography (CT) hip scans altered patient management and whether two X-ray projections of the hip affected fracture detection rate. A total of 447 (63.6%) CT hips were performed to exclude an occult fracture, which was only detected in 108 (24.1%) of the scans requested. The majority were subcapital (n = 58, 53.7%) or intertrochanteric (n = 39, 36.1%). There was no significant difference between fracture detection rates when comparing one and two views of the pelvis. 82.4% (n = 89) of occult hip fractures were managed operatively. CT imaging led to a change in patient management in 20% of cases. 3
26. Baffour FI, Glazebrook KN, Morris JM, et al. Clinical utility of virtual noncalcium dual-energy CT in imaging of the pelvis and hip. [Review]. Skeletal Radiology. 48(12):1833-1842, 2019 Dec. Review/Other-Dx N/A To present a clinical perspective of our experience using virtual noncalcium images in the work up of pelvic osseous pathology. No results stated in abstract. 4
27. Kellock TT, Nicolaou S, Kim SSY, et al. Detection of Bone Marrow Edema in Nondisplaced Hip Fractures: Utility of a Virtual Noncalcium Dual-Energy CT Application. Radiology. 284(3):798-805, 2017 09. Observational-Dx 118 patients who presented who underwent dual-energy CT for suspicion of a nondisplaced traumatic To quantify the sensitivity and specificity of dual-energy computed tomographic (CT) virtual noncalcium images in the detection of nondisplaced hip fractures and to assess whether obtaining these images as a complement to bone reconstructions alters sensitivity, specificity, or diagnostic confidence. Twenty-two patients had nondisplaced hip fractures and 96 did not have hip fractures. Sensitivity with virtual noncalcium images was 77% and 91% (17 and 20 of 22 patients), and specificity was 92%-99% (89-95 of 96 patients). Sensitivity increased by 4%-5% over that with bone reconstruction images alone for two of the three readers when both bone reconstruction and virtual noncalcium images were used. Specificity remained unchanged (99% and 100%). Diagnostic confidence in the exclusion of fracture was improved with combined bone reconstruction and virtual noncalcium images (median score: 10, 9, and 10 for readers 1, 2, and 3, respectively) compared with bone reconstruction images alone (median score: 9, 8, and 9). 2
28. Rogers NB, Hartline BE, Achor TS, et al. Improving the Diagnosis of Ipsilateral Femoral Neck and Shaft Fractures: A New Imaging Protocol. Journal of Bone & Joint Surgery - American Volume. 102(4):309-314, 2020 Feb 19. Review/Other-Dx 37 patients with 39 acute, high-energy femoral shaft fractures resulting from blunt trauma To determine if the preoperative diagnosis of ipsilateral femoral neck fractures in patients with high-energy femoral shaft fractures can be improved with magnetic resonance imaging (MRI) compared with radiographic and CT imaging. The average age of the patients was 29.1 years (range, 14 to 82 years). Ten (25.6%) of the 39 femoral shaft fractures were open. Two femoral shaft fractures (5.1%) were associated with ipsilateral femoral neck fractures that were detected on radiographs, and no MRI was performed. None of the remaining 37 femoral shaft fractures were associated with a femoral neck fracture that was identified on CT imaging. Thirty-three (89.2%) of 37 patients underwent pelvic MRI to evaluate the ipsilateral femoral neck. Four (12.1%) of those 33 patients were diagnosed with a femoral neck fracture (2 complete, 2 incomplete) that was not identified on thin-cut high-resolution CT or radiographic imaging. 4
29. Khurana B, Okanobo H, Ossiani M, Ledbetter S, Al Dulaimy K, Sodickson A. Abbreviated MRI for patients presenting to the emergency department with hip pain. AJR Am J Roentgenol. 2012;198(6):W581-588. Observational-Dx 385 patients To assess the diagnostic performance of two abbreviated hip Magnetic Resonance Imaging (MRI) protocols--coronal Short tau inversion recovery (STIR) images only and coronal STIR with coronal T1-weighted images--as compared with a full hip MRI protocol in patients presenting to the emergency department (ED) with hip pain and negative radiographic findings. MRI detected findings suspicious for fracture in 42% (162/385) of patients, for avascular necrosis (AVN) in 9% (33/385), and for muscle injury in 35% (134/385). The sensitivity and specificity of STIR alone in raising concern for fracture was 99% (220/223) for both readers, with small incremental benefits of adding coronal T1-weighted images. For AVN, specificity was 100% (28/28) with STIR alone, but the addition of coronal T1-weighted images provided substantial benefit by increasing sensitivity from 85% (28/33) to 97% (32/33). For muscle injury, sensitivity and specificity exceeded 95% (128/134) for both abbreviated examinations. 2
30. Sun EX, Mandell JC, Weaver MJ, Kimbrell V, Harris MB, Khurana B. Clinical utility of a focused hip MRI for assessing suspected hip fracture in the emergency department. Emergency Radiology. 28(2):317-325, 2021 Apr. Review/Other-Dx 71 patients with one or more fractures identified by FHMR To assess the clinical utility of a focused hip MRI (FHMR) for the detection of radiographically occult hip fractures was implemented in our emergency department (ED). Seventy-one patients had one or more fractures identified by FHMR: one-third had proximal femoral fractures; two-third had pelvic fractures. Of these 71 patients, 53 (74%) had radiographically occult fractures, including 14 (20%) with occult proximal femoral fractures; 4 patients had fractures occult on CT. Nineteen patients with a suspected fracture on radiography were found to have no fracture on FHMR. Four fractures not reported on FHMR were later seen on follow-up imaging: these included 1 isolated greater trochanter, 1 additional ischial tuberosity, 1 additional superior pubic ramus, and 1 additional sacrum. All four fractures were treated non-operatively. Muscle/tendon injury was the most common type of injury, seen in 50% (130/262) patients with the most commonly torn tendons being the hamstring (44%; 15/34) followed by gluteus medius tendon (18%; 6/34). A full-hip or pelvis MRI was done after FHMR in only 5 patients, primarily for the purpose of better characterizing findings already identified on FHMR (2 for fracture, 2 for tendon injury, 1 for soft tissue metastasis). Only one of these five studies provided new information: ruling out a previously questioned fracture. Clinical management of the vast majority of patients was based solely on findings from the FHMR. 4
31. Wilson MP, Nobbee D, Murad MH, et al. Diagnostic Accuracy of Limited MRI Protocols for Detecting Radiographically Occult Hip Fractures: A Systematic Review and Meta-Analysis. [Review]. AJR. American Journal of Roentgenology. 215(3):559-567, 2020 09. Meta-analysis 5 studies To evaluate the diagnostic accuracy o flimited MRI protocols for detecting radiographically occult proximal femoral fractures compared with a multiparametric MRI protocol with or without clinical outcome as the reference standard. Eleven studies with 938 patients and 247 proximal femoral fractures met inclusion criteria, and five of these studies were included in the meta-analysis. The pooled and weighted summary sensitivity and specificity and the area under the summary ROC curve for limited MRI protocols in detecting radiographically occult hip fractures were 99% (95% CI, 91-100%), 99% (95% CI, 97-100%), and 1 (95% CI, 0.99-1), respectively. The aggregate sensitivity and specificity values for a single-plane T1-weighted sequence only, STIR sequence only, T1-weighted and STIR sequences, and T2-weighted sequence only were as follows: 97% (89/92) and 100% (76/76), 99% (126/127) and 99% (865/873), 100% (118/118) and 99% (867/874), and 86% (51/59) and 97% (137/141), respectively. Sensitivity was 100% (58/58) when images were acquired on 3-T scanners only and 99% (284/288) when interpreted only by certified radiologists. The mean scanning time for the limited MRI protocols was less than 5 minutes. Not Assessed
32. Cohen A, Li T, Greco J, et al. Hip effusions or iliopsoas hematomas on ultrasound in identifying hip fractures in the emergency department. American Journal of Emergency Medicine. 64:129-136, 2023 02. Observational-Dx 213 patients We evaluated the sensitivity, specificity, predictive values, and likelihood ratios of hip effusion and/or iliopsoas hematoma on point-of-care ultrasound (POCUS) performed by ultrasound fellows and fellowship trained emergency providers to identify hip fractures in emergency department (ED) patients with a high suspicion of hip fracture. Among 213 patients analyzed, all 213 received an x-ray, 116 received a CT scan, and 14 received an MRI; 113/213 x-rays (53.1%), 35/116 CT scans (30.2%), and 7/14 MRIs (50.0%) were positive for a hip fracture. A total of 123 patients were diagnosed with a hip fracture (57.7%). There were 13 false negative x-ray results. Overall, compared with the reference standard of x-ray, CT, or MRI, POCUS had a sensitivity of 97% (95% CI: 94%, 100%), specificity of 70% (95% CI: 61%, 79%), PPV of 82% (95% CI: 75%, 88%), and NPV of 94% (95% CI: 88%, 100%) in the identification of hip fractures; with a positive likelihood ratio of 3.22 (95% CI: 2.35, 4.43) and negative likelihood ratio of 0.05 (95% CI: 0.02, 0.12). 1
33. Tsukamoto H, Kijima H, Saito K, Saito H, Miyakoshi N. Diagnostic accuracy of ultrasonography for occult femoral neck fracture. Journal of Clinical Orthopaedics & Trauma. 36:102087, 2023 Jan. Observational-Dx 94 outpatients aged above 70 years with acute hip pain but without radiographic abnormal findings who were suspected of having an occult femoral neck To investigate the diagnostic accuracy of ultrasonography for OFNF in patients confirmed with this condition by magnetic resonance imaging (MRI), and compare these results with other clinical findings. By MRI findings, 27 patients were assigned to an occult femoral neck fracture (OFNF) group (1 man, 26 women) and 67 patients to a non-OFNF group (10 men, 57 women). The mean ultrasound joint swelling in both groups was 7.53 ± 1.52 mm and 3.45 ± 0.89 mm, respectively (p = 0.006, 95% CI, 3.58-4.59). A cut-off value of 5.3 mm showed a sensitivity of 0.96 (0.89-0.96) and a specificity of 0.98 (0.92-1.00). 4
34. Zamora T, Klaber I, Ananias J, et al. The influence of the CT scan in the evaluation and treatment of nondisplaced femoral neck fractures in the elderly. Journal of Orthopaedic Surgery. 27(2):2309499019836160, 2019 May-Aug. Observational-Dx 11 patients a nondisplaced (Garden 1-2) FNF To assess the impact of a computed tomography scan (CT) on interobserver agreement (IA) of fracture classification, posterior tilt measurement, and treatment decisions in nondisplaced FNF in elderly patients. IA for Garden classification was only slight in X-rays and with the addition of a CT, with a ? = 0.13 (0-0.28) and 0.18 (0.03-0.33), respectively. Conversely, posterior tilt measurement agreement was excellent in both schemes, with an ICC = 0.92 (0.83-0.98) and 0.92 (0.82-0.98). The IA for the proposed treatment was slight with X-rays ( ? = 0.44; 0.29-0.6), but moderate with the addition of a CT scan ( ? = 0.67; 0.52-0.82). Changes in surgical decision where made in 14 of 66 evaluations with an OR = 1.4 (0.62-3.2) for choosing an arthroplasty if a CT was used. 2
35. Hardy J, Collin C, Mathieu PA, Vergnenegre G, Charissoux JL, Marcheix PS. Is non-operative treatment still relevant for Garden Type I fractures in elderly patients? The femoral neck impaction angle as a new CT parameter for determining the indications of non-operative treatment. Orthopaedics & traumatology, surgery & research. 105(3):479-483, 2019 05. Observational-Dx 49 patients aged 65 years or over with Garden I fractures treated non-operatively To assess whether two computed tomography (CT) parameters, the femoral neck impaction angle (IA) and the femoral neck posterior tilt angle (PTA), were effective in predicting the risk of secondary displacement after non-operative treatment of Garden I femoral neck fractures in patients aged 65 years or over. After non-operative treatment, secondary displacement occurred in 22 (45%) patients. The PTA was not significantly different between the groups with vs. without secondary displacement (p=0.62). IA values=135° were significantly associated with secondary displacement (odds ratio, 11.73; 95% confidence interval [95%CI], 3.04-45.28; p=0.004). An IA=135° was 72.73% sensitive and 81.48% specific for predicting secondary displacement. IA measurement was reproducible, with intra-class and inter-class Cohen's kappa values of 0.94 (95%CI, 0.90-0.97) and 0.9011 (95%CI, 0.83-0.94), respectively. 3
36. Iguchi M, Takahashi T, Matsumura T, et al. Addition of 3D-CT evaluation to radiographic images and effect on diagnostic reliability of current 2018 AO/OTA classification of femoral trochanteric fractures. Injury. 52(11):3363-3368, 2021 Nov. Observational-Dx 89 cases with Radiographs and 3D-CT images To test the hypothesis that the addition of three-dimensional CT (3D-CT) to radiographic diagnosis would improve diagnostic reliability. In the first assessment, the Kappa value indicated fair inter-rater reliability in all groups (high-experience group: k = 0.296, 95% confidence interval [CI] 0.239-0.352; intermediate-experience group: k = 0.367, 95% CI 0.305-0.428; low-experience group: k = 0.304, 95% CI 0.246-0.362). With the addition of 3D-CT (second assessment), reliability improved from fair to moderate in the high- and intermediate-experience groups (k = 0.483, 95% CI 0.428-0.539 and k = 0.409, 95% CI 0.352-0.466, respectively). By contrast, reliability remained fair in the low-experience group (k = 0.322, 95% CI 0.322-0.431). The inter-rater reliability of diagnosing subgroup fracture types improved for A2.3 and A3.1 in all three groups and for A3.2 and A3.3 in the intermediate- and low-experience groups. 4
37. Wada K, Mikami H, Amari R, Toki S, Takai M, Sairyo K. A novel three-dimensional classification system for intertrochanteric fractures based on computed tomography findings. Journal of Medical Investigation. 66(3.4):362-366, 2019. Observational-Dx 95 patients with intertrochanteric fracture To determine the frequency of intertrochanteric fractures in the elderly population using the fragment-based classification system based on CT findings. Ninety-five intertrochanteric fractures were classified by the same surgeon. The fractures occurred in 14 men and 81 women with a mean age of 84.7 years. The frequency of each type of fracture was investigated. Thirty-one fractures (32.6%) were 2-fragment and 64 (67.4%) were = 3-fragment. A fragment of the anterior portion of the greater trochanter, which cannot be classified using conventional systems, was included in 29 cases (30.5%). A 5-fragment fracture was detected in two cases (2.1%). 3
38. Wada K, Mikami H, Toki S, Amari R, Takai M, Sairyo K. Intra- and inter-rater reliability of a three-dimensional classification system for intertrochanteric fracture using computed tomography. Injury. 51(11):2682-2685, 2020 Nov. Observational-Dx 203 with intertrochanteric fracture To test the hypothesis that three-dimensional classification by CT has better intra- and inter-observer reliability than conventional two-dimensional classification. The kappa values for the two-dimensional Evans-Jensen and AO/OTA classification systems showed moderate intra-observer reliability (?=0.65 and ?=0.61, respectively) and slight inter-observer reliability (?=0.20 and ?=0.19). The intra-observer kappa value for the three-dimensional classification system was 0.88, indicating almost perfect reliability; the inter-observer kappa value was 0.70, indicating substantial reliability. 4
39. Noh J, Lee KH, Jung S, Hwang S. The Frequency of Occult Intertrochanteric Fractures among Individuals with Isolated Greater Trochanteric Fractures. Hip & Pelvis. 31(1):23-32, 2019 Mar. Observational-Dx 100 cases of isolated GT fractures To determine the frequency of occult intertrochanteric fractures in patients diagnosed with isolated GT fractures using plain radiographs. Among the 100 cases of isolated GT fractures diagnosed using plain radiograph, additional examinations revealed that 10 (10.0%) were suffering from isolated GT fractures alone, while the remaining 90 (90.0%) were further diagnosed with occult intertrochanteric fracture. Gender, age, mechanism of injury, and bone mineral density did not correlate with fracture type. 3
40. Walsh PJ, Farooq M, Walz DM. Occult fracture propagation in patients with isolated greater trochanteric fractures: patterns and management. Skeletal Radiology. 51(7):1391-1398, 2022 Jul. Review/Other-Dx 146 patients who had follow-up MRI after identification of a greater trochanteric fracture without intertrochanteric extension on radiography or CT To demonstrate the degrees of occult intertrochanteric extension on MRI in patients with a greater trochanteric fracture on radiography or computer tomography (CT) and whether these patients undergo conservative or surgical management with hardware. Nineteen patients had horizontal greater trochanter fractures without intertrochanteric extension; none underwent surgery. Seventeen patients had a vertical fracture along the lateral femoral cortex; one underwent surgery. Thirty-three patients had a fracture with intertrochanteric extension less than 50% in the mid coronal plane; 21 underwent surgery. Forty patients had intertrochanteric extension greater than 50% in the midcoronal plane not contacting the medial cortex; 28 underwent surgery. Thirty-seven patients had fractures contacting the medial cortex; 28 underwent surgery. There was significant difference with fractures extending 50% or greater of the midline of the intertrochanteric region undergoing surgical management compared with fractures less than 50% (p < 0.0001). 4
41. Kent WT, Whitchurch T, Siow M, et al. Greater trochanteric fractures with lntertrochanteric extension identified on MRI: What is the rate of displacement when treated nonoperatively?. Injury. 51(11):2648-2651, 2020 Nov. Review/Other-Dx 15 patients with nonoperatively treated GT fractures To evaluate the rate at which greater trochanteric (GT) fractures with intertrochanteric (IT) extension displaced, requiring operative fixation. Seventeen patients met initial inclusion criteria, with two subsequently excluded due to no radiographic follow-up. Of the 15 patients, zero had displacement of their IT fracture. None required operative intervention. All 15 patients healed their fractures. Fourteen of 15 (93%) had IT extension of 50% or less across the IT region. One patient had initial IT extension of 60%, this patient also healed without displacement. 4
42. Mandell JC, Marshall RA, Banffy MB, Khurana B, Weaver MJ. Arthroscopy After Traumatic Hip Dislocation: A Systematic Review of Intra-articular Findings, Correlation With Magnetic Resonance Imaging and Computed Tomography, Treatments, and Outcomes. Arthroscopy. 34(3):917-927, 2018 03. Review/Other-Dx 31 heterogeneous case series and case reports (151 patients who underwent arthroscopy after traumatic hip dislocation) To describe the literature concerning patient demographic characteristics and intra-articular injury seen at arthroscopy after traumatic hip dislocation, describe the reported computed tomography (CT) and magnetic resonance findings with arthroscopic correlation, and describe the reported arthroscopic treatments performed with complications and outcomes. Thirty-one heterogeneous case series and case reports were included in the analysis from the initial search yielding 780 results, including reports of 151 patients who underwent arthroscopy after traumatic hip dislocation. A wide spectrum of intra-articular injury was reported, with a high prevalence of labral tears, intra-articular bodies, ligamentum teres injuries, and chondral damage. CT had a sensitivity of 87.3% for detecting intra-articular fragments; however, 43.3% of patients who had a preoperative CT scan with negative findings for intra-articular fragments did show fragments at arthroscopy. Magnetic resonance had a sensitivity of 95.0% for detecting labral tears. There were no major complications directly attributed to arthroscopic surgery. A total of 75 of 151 patients were followed up for a median of 2 years after surgery, with osteoarthritis reported in 4.0% and avascular necrosis in 2.7%. 4
43. Mullis BH, Dahners LE. Hip arthroscopy to remove loose bodies after traumatic dislocation. J Orthop Trauma 2006;20:22-6. Review/Other-Dx 36 patients who sustained traumatic hip injuries and subsequently had 39 hip arthroscopies To review the incidence of arthroscopically detected intra-articular loose bodies found in patients after traumatic hip dislocation or small acetabular wall fracture which would not otherwise be treated without surgery. Loose bodies were found in the hips of 33 of 36 patients (92%) who were arthroscoped. Loose bodies were found in 7 of 9 cases (78%) in which standard radiographic studies (AP pelvis x-rays and CT scan) found no loose bodies and a concentric reduction. 4
44. Chona DV, Minetos PD, LaPrade CM, et al. Hip Dislocation and Subluxation in Athletes: A Systematic Review. American Journal of Sports Medicine. 50(10):2834-2841, 2022 08. Review/Other-Tx N/A To systematically review treatment strategies and outcomes for hip dislocation in athletes, with the ultimate goal of providing sports medicine physicians with the information necessary to appropriately treat and counsel patients sustaining this injury. No results stated in abstract. 4
45. Chung CB, Robertson JE, Cho GJ, Vaughan LM, Copp SN, Resnick D. Gluteus medius tendon tears and avulsive injuries in elderly women: imaging findings in six patients. AJR Am J Roentgenol 1999;173:351-3. Review/Other-Dx 6 patients To describe the imaging findings of tears and avulsive injuries of the gluteus medius tendon in elderly women and to evaluate the importance of diagnosis and the implications of treatment in the realm of lateral hip pain. No results in abstract. 4
46. Cvitanic O, Henzie G, Skezas N, Lyons J, Minter J. MRI diagnosis of tears of the hip abductor tendons (gluteus medius and gluteus minimus). AJR Am J Roentgenol 2004;182:137-43. Observational-Dx MRIs of 74 hips (in 45 patients) To determine the accuracy of MRI for diagnosing tears of the hip abductor tendons (gluteus medius and gluteus minimus) and to evaluate various signs of tendon disruption. The accuracy of MRI for the diagnosis of tears of the abductor tendons was 91%. Statistically significant associations were found between tears of the abductor tendons and areas of high signal intensity superior to the greater trochanter on T2-weighted images (p < 0.0001), tendon elongation in the gluteus medius (p = 0.0028), tendon discontinuity (p = 0.016), and areas of high signal intensity lateral to the greater trochanter on T2-weighted images (p = 0.0213). Interobserver agreement was good to fair. 3
47. Lequesne M, Djian P, Vuillemin V, Mathieu P. Prospective study of refractory greater trochanter pain syndrome. MRI findings of gluteal tendon tears seen at surgery. Clinical and MRI results of tendon repair. Joint Bone Spine 2008;75:458-64. Observational-Dx 8 patients with MR images of tear of the lateral part of the gluteus medius tendon (1) To compare MRI and surgical findings in patients with refractory greater trochanter pain syndrome and (2) to assess surgical outcomes. All were women, aged 71.1 (SD: 9.4). Mean symptoms duration before surgery: 14.3 months (11.8). Surgery confirmed the presence of a tear of the lateral part of the gluteus medius tendon in all eight patients, with an associated tear of its main tendon in one patient, all tears revealed on MRI. An associated tear of the gluteus minimus tendon was present at surgery in five patients, of which three were not seen on MRI (false negative). Bursitis was confirmed in all eight patients. Steady complete remission of spontaneous and provoked (physical examination) pain was observed in seven patients and partial remission in one (mean follow-up: 22.4 months (SD: 16.3)). Six MRIs performed after 20+/-12 months showed good reinsertion of the sutured tendon. 1
48. Lindner D, Shohat N, Botser I, Agar G, Domb BG. Clinical presentation and imaging results of patients with symptomatic gluteus medius tears. J Hip Preserv Surg 2015;2:310-5. Review/Other-Dx 45 patients (47 hips) who underwent GM repair for the diagnosis of tear To characterize the clinical history, physical examination, imaging findings and intraoperative findings in patients presenting with symptomatic gluteus medius (GM) tears. Pain was estimated on the visual analog scale (VAS) and hip-specific scores were administered to assess functional status. The imaging modalities were reviewed and intra operative findings were recorded. The average patient age was 54 years (17-76), 93% were females. Symptom onset was commonly insidious (75%) and the average time to diagnosis was 28 months (2-240). The most common pain location was the lateral hip (75%). The average pre-surgery VAS and modified Harris Hip Score were 6.65 (0-10) and 55.5 (12-90), respectively. All patients had pathological findings on magnetic resonance angiogram (MRA) ranging from tendinosis to complete tears of the GM tendon. There was a discrepancy between MRA interpretation by a radiologist and findings during surgery. 4
49. Makridis KG, Lequesne M, Bard H, Djian P. Clinical and MRI results in 67 patients operated for gluteus medius and minimus tendon tears with a median follow-up of 4.6 years. Orthop Traumatol Surg Res 2014;100:849-53. Observational-Dx 73 patients To determine (1) if functional improvement can be obtained, (2) if the repairs are continuous based on MRI, and (3) which factors determine success. The average follow-up was 4.6 years (range 1-8). The pre-operative scores had improved at the last follow-up: (1) pain (VAS): 8.7 ± 1.1 versus 1.7 ± 2.7 at the follow-up, (P<0.001), (2) Lequesne index: 12.3 ± 2.6 versus 4.0 ± 4.0 at the follow-up, (P<0.001), (3) Harris Hip Score: 50.5 ± 8 versus 87.9 ± 15.5 at the follow-up, (P<0.001). There were 11 failures (16%) including two repeat tears that were reoperated successfully. In the other 56 patients, the MRI showed no signs of the initial tear or bursitis. Of the four factors (age, BMI, fatty degeneration, muscle atrophy) that were potential predictors of the outcome, only muscle atrophy had a negative impact on functional outcome (P<0.05). 2
50. Zhu MF, Musson DS, Cornish J, Young SW, Munro JT. Hip abductor tendon tears: where are we now?. [Review]. Hip International. 30(5):500-512, 2020 Sep. Review/Other-Dx N/A To summarise the known anatomy, pathology and management of abductor tendon tears No results in abstract. 4
51. Westacott DJ, Minns JI, Foguet P. The diagnostic accuracy of magnetic resonance imaging and ultrasonography in gluteal tendon tears--a systematic review. Hip Int 2011;21:637-45. Meta-analysis 7 studies To systematically review the peer-reviewed literature to establish the accuracy of magnetic resonance imaging and ultrasonography in the diagnosis of gluteal tendon tears in patients with persistent lateral hip pain or Greater Trochanteric Pain Syndrome (GTPS). MRI had sensitivity of 33-100%, specificity of 92-100%, positive predictive value of 71-100% and negative predictive value of 50%. False-positives were common. High signal located superior to the trochanter had a stronger association with tears. Ultrasonography had a sensitivity of 79-100% and positive predictive value of 95-100%. M
52. Allahabadi S, Salazar LM, Obioha OA, Fenn TW, Chahla J, Nho SJ. Hamstring Injuries: A Current Concepts Review: Evaluation, Nonoperative Treatment, and Surgical Decision Making. American Journal of Sports Medicine. 3635465231164931, 2023 Apr 24. Review/Other-Tx N/A To highlight the evaluation and workup of hamstring injuries, nonoperative treatment options, and surgical decision-making based on patient presentation and injury patterns. No results stated in abstract. 4
53. Arner JW, McClincy MP, Bradley JP. Hamstring Injuries in Athletes: Evidence-based Treatment. J Am Acad Orthop Surg 2019;27:868-77. Review/Other-Tx N/A To discuss the appropriate diagnosis and treatment, with physical therapy, biologic treatments, and surgical repairs. No results stated in abstract. 4
54. Koulouris G, Connell D. Evaluation of the hamstring muscle complex following acute injury. Skeletal Radiol 2003;32:582-9. Review/Other-Dx 170 patients with hamstring muscle complex (HMC) strain To evaluate the imaging findings following acute hamstring injury. Twenty-one patients had proximal tendon injury, with sixteen avulsions and five partial tears. Sixteen of these patients had surgical confirmation of hamstring avulsion from the ischial tuberosity (14 conjoint, 2 biceps femoris alone) and all were reliably diagnosed with MR imaging (16/16), but less so with sonography (7/12). Four distal tendon avulsions were also observed (three semitendinosus, one biceps femoris). With respect to muscle injury, the biceps femoris was most commonly injured (124/154). Semimembranosus was an uncommon muscle injury (21/154) and semitendinosus rare (9/154). 4
55. Forlizzi JM, Nacca CR, Shah SS, et al. Acute Proximal Hamstring Tears Can be Defined Using an Imaged-Based Classification. Arthroscopy, Sports Medicine, and Rehabilitation. 4(2):e653-e659, 2022 Apr. Observational-Dx 114 patients To develop a clinically meaningful proximal hamstring tear classification system and to present outcome data for defined subtypes. At a mean follow-up of 38.6 (range: 12-94) months for 114 patients, distributions were as follows: 18.4% Type 1A, 19.2% Type 1B, 7.8% Type 2c, 3.5% Type 2s, and 50.9% Type 3. Intra-observer and inter-observer reliability had a mean Kappa of 0.985 (95% CI: .956, 1.01) and .905 (95% CI: .895 .915). 66 patients underwent surgery, with 68.97% of them being Type 3. The mean HOS-ADL and PASS rate were higher for operatively treated patients (95%, 93.4%) than for nonoperatively treated patients (81.86%, 44.7%). There were significantly more patients satisfied in the surgery group in both Type 1 and Type 3 tears (P = .046 and P = .049). Body mass index was a significant predictor of a poor outcome in Type 3 tears (P = .039). 3
56. Lungu E, Michaud J, Bureau NJ. US Assessment of Sports-related Hip Injuries. [Review]. Radiographics. 38(3):867-889, 2018 May-Jun. Review/Other-Dx N/A To discuss the assessment of joint effusion, acetabular labral tear, acute and chronic tendon injuries including tendinopathy, partial and full-thickness tears, snapping hip syndromes, relevant US-guided procedures, and some other conditions such as Morel-Lavallée lesion and perineal nodular induration. No results stated in abstract. 4
57. Boric I, Isaac A, Dalili D, Ouchinsky M, De Maeseneer M, Shahabpour M. Imaging of Articular and Extra-articular Sports Injuries of the Hip. [Review]. Seminars in Musculoskeletal Radiology. 23(3):e17-e36, 2019 Jun. Review/Other-Dx N/A To describes the intra-articular pathologies encountered in sports activities including labrum or cartilage lesions, associated or not with femoroacetabular hip impingement syndromes, as well as ligament teres injuries, using magnetic resonance imaging (MRI) or computed tomography arthrography. No results stated in abstract. 4
58. Kho J, Azzopardi C, Davies AM, James SL, Botchu R. MRI assessment of anatomy and pathology of the iliofemoral ligament. [Review]. Clinical Radiology. 75(12):960.e17-960.e22, 2020 12. Review/Other-Dx N/A To review the magnetic resonance imaging (MRI) appearances of the iliofemoral ligament, and discuss the disease entities that may affect this region. No results stated in abstract. 4
59. Fearon AM, Scarvell JM, Cook JL, Smith PN. Does ultrasound correlate with surgical or histologic findings in greater trochanteric pain syndrome? A pilot study. Clin Orthop Relat Res 2010;468:1838-44. Review/Other-Dx 24 patients who had combined gluteal tendon reconstruction and bursectomy (1) to calculate the sensitivity and positive predictive value of preoperative ultrasound assessment for GTPS; (2) to report the outcomes of gluteal tendon reconstructive surgery using validated clinical and functional outcome tools; and (3) to describe the histopathologic features of tendon and bursa specimens collected at the time of reconstructive surgery. In our small study, ultrasound had a high positive predictive value for gluteal tendon tears (positive predictive value = 1.0). Patients reported high levels of pain relief and function after surgery; tendon and bursa showed pathologic changes. 4
60. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022. Review/Other-Dx N/A Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. No abstract available. 4
61. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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