Review Article: Magnetic Resonance Imaging and Computed Tomography in the Diagnosis of Occult Proximal Femur Fractures

Abstract

Electronic databases of MEDLINE, EMBASE, CINAHL, and the Cochrane Library as well as the Google Scholar search engine were used. Studies written in the English language highlighting the use of magnetic resonance imaging (MRI) and computed tomography in diagnosing occult proximal femoral fractures despite negative or equivocal plain radiographs were included. Two reviewers independently extracted data from each article. Raw frequencies for each of the details investigated were calculated. 15 prospective and 7 retrospective studies from 1989 to 2009 were included in this systematic review. A total of 996 patients (mean age, 75 years; standard deviation, 5 years) with suspected occult proximal femur fractures underwent MRI for further assessment. 350 (35%) of the patients tested positive for proximal femoral fractures, of whom 295 (84%) underwent further treatment/surgical interventions. MRI also detected other fractures and soft-tissue injuries. MRI was superior to other imaging modalities in diagnosing occult proximal femoral fractures and should be performed within 24 hours of injury. Early diagnosis and management may avoid substantial displacement and complications, and improve overall mortality and morbidity.

The validity of investigating occult hip fractures using multidetector CT

“…14 The Guideline Development Group is currently overseeing the development of guidelines for the management of hip fractures in adults and recently recommended research into the clinical and cost-effectiveness of CT compared with MRI in confirming or excluding a fracture. 1 Their evidence update in March 2013 includes a systematic review by Chatha et al 15 (2011). 15 prospective studies and 7 retrospective studies from 1989 to 2009 were included in this review.…”

Interesting skeletal radiologic and scintigraphic outcomes and their logical clinical conclusions

“…Despite absence of any cognizable or revealed injury, unrecognized stress induced subclinical trauma results in occult subchondral femoral head fractures which on skeletal scintigraphy show up as diffuse uptake in the femoral head and neck region and mimic infection or tumor[ 11 ] [ Figure 6a ]. MRI answers the issue with the classical features of subchondral fracture separating from metastasis[ 12 13 ] [ Figure 6b ].…”

Radiographically Occult and Subtle Fractures: A Pictorial Review

“…The diagnostic performance of MRI in the detection of occult fractures has been shown to be comparable [12], or better [13–17] than MDCT. Indeed, while the specificity of both CT and MRI for the diagnosis of fracture can be as high as 100% [18], the sensitivity was reported to be higher for MRI [13–16].…”