DIAGNOSTIC ACCURACY OF X-RAY COMPARED WITH COMPUTED TOMOGRAPHY FOR DETECTION OF NON-DISPLACED FRACTURES IN PAKISTAN

Abstract

Non-displaced fractures may be difficult to identify on conventional radiographs because the fracture fragments remain anatomically aligned and the fracture line can be subtle or occult. This study evaluated the diagnostic accuracy of plain X-ray for detection of non-displaced fractures using computed tomography (CT) as the reference standard. A cross-sectional observational study was conducted over three months in the Radiology Department of Ghurki Trust Teaching Hospital, Lahore, Pakistan. Sixty-two symptomatic patients aged 1–70 years with localized pain, swelling, tenderness, or restricted movement following trauma were included using convenient sampling. Each participant underwent X-ray followed by CT, and findings were compared using a 2×2 diagnostic classification. CT identified positive findings in 47/62 participants (75.81%), whereas X-ray was positive in 24/62 (38.71%). Against CT, X-ray yielded 20 true positives, 11 true negatives, 4 false positives, and 27 false negatives. The resulting sensitivity was 42.55% and specificity was 73.33%; the derived positive predictive value was 83.33%, negative predictive value 28.95%, and overall accuracy 50.00%. The large number of false-negative radiographs demonstrates the limitation of plain radiography for subtle, non-displaced fractures. X-ray remains useful because it is rapid, inexpensive, widely available, and involves less radiation than CT; however, CT should be considered when clinical suspicion remains high despite a negative or equivocal radiograph. Imaging decisions should balance diagnostic benefit with radiation exposure according to the ALARA principle. Larger multicenter studies using standardized anatomical subgroups and low-dose CT protocols are warranted.