Pelvis/Hip Case 7 Diagnosis

By definition, plain film radiographs are negative in occult hip fractures.

The American College of Radiology addresses this scenario in its evidence based ACR Appropriateness Criteria. https://acsearch.acr.org/docs/3082587/Narrative

According to the ACR appropriateness criteria:

• MRI is 100% sensitive and is the gold standard test.
• CT and MRI, both without contrast, are given the highest rating of “usually appropriate”.
• Given the importance of rapid diagnosis in decreasing fracture-related morbidity, the relative speed in obtaining CT (versus MRI or bone scan) supports CT as the next imaging examination after negative radiographs when there is persistent clinical concern for hip fracture. Patients with persistent clinical concern for hip fracture after a negative or equivocal CT will still need an MRI.