title: Imaging of occult hip fractures: CT or MRI?
abstract: OBJECTIVE
  Patients presenting with hip pain but normal plain radiographs may ultimately be shown on further investigation to have suffered an occult hip fracture (OHF). This diagnosis can be made with CT or MRI. Traditionally MRI has been considered a superior modality. We performed a retrospective review of all patients presenting to our service with a suspected OHF over a four-year period, investigated with either CT or MRI.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Urban trauma centre.
  
  
  METHODS
  Patients with suspected hip fractures and negative radiographs.
  
  
  METHODS
  CT or MRI.
  
  
  METHODS
  Detection rate; delay in request for further imaging; delay to theatre; re-presentations with missed fractures.
  
  
  RESULTS
  A total of 179 patients were investigated, with a mean age of 82±13 years. The ultimate diagnosis was of an OHF in 71 cases and pelvic or acetabular fracture in 34. The average time from presentation plain radiograph to further imaging was 2.0±2.7 days, but was significantly shorter for CT. No patient re-presented with unidentified fractures or other localised hip pathology within a 12-month period.
  
  
  CONCLUSIONS
  Modern imaging technology does not appear to miss clinically significant fractures. As CT is usually more accessible than MRI, the results of our study should encourage surgeons to consider CT as a first line investigation for occult hip fractures. We advocate a high index of suspicion and early imaging referral for elderly patients presenting with non-specific hip pain following a fall. Level 3 Evidence.
authors.affiliation: Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, Scotland. Electronic address: haroon.rehman.06@aberdeen.ac.uk.
authors.forename: Haroon
authors.initials: H
authors.lastname: Rehman
authors.affiliation: Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, Scotland.
authors.forename: Rhys G E
authors.initials: RG
authors.lastname: Clement
authors.affiliation: Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, Scotland.
authors.forename: Fergus
authors.initials: F
authors.lastname: Perks
authors.affiliation: Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, Scotland.
authors.forename: Timothy O
authors.initials: TO
authors.lastname: White
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D005596:Fractures, Closed / Q000000981:diagnostic imaging* / Q000473:pathology; D006620:Hip Fractures / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D017410:Practice Guidelines as Topic; D011859:Radiography; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012606:Scotland; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers
keywords: CT; MRI; Occult hip fractures