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MRI diagnosis of occult hip fractures
Frede Frihagen1, Lars Nordsletten, Rana Tariq
1Orthopedic Center, Musculoskeletal Division, Ullevål University Hospital, Oslo, Norway. frede.frihagen@uus.no
Background:
Most fractures of the proximal femur are easily diagnosed by conventional radiography. When the images are judged to be negative or equivocal and a clinical suspicion of fracture persists, another approach is to use magnetic resonance imaging (MRI) to help reach a diagnosis.
Methods:
In a prospective study running from November 1998 to December 2001, we registered all patients being examined by MRI who had had a negative or equivocal radiograph and where there was continued clinical suspicion of hip fracture.
Results:
100 consecutive patients (67 women) were included, with an average age of 80 (37-100) years. The MRI examinations corresponded to 4% of the 2,350 patients admitted with hip trauma during the study period. 46 patients had a femoral neck or intertrochanteric fracture on MRI. 27 patients had other fractures. 18 had other findings on MRI, and 10 were interpreted as being negative, although one of these was a false negative. In a separate interobserver analysis, two experienced radiologists agreed on the diagnoses in 19/23 cases (kappa value 0.78). They agreed with a less experienced radiologist in 17/23 and 19/23 cases, respectively (kappa values 0.66 and 0.76).
Interpretation:
MRI is a useful tool for demonstration of occult hip fractures. In the absence of a hip fracture, another explanation for the patient's pain and disability will often be given.
Insights
Magnetic resonance imaging (MRI) effectively diagnoses occult hip fractures when initial X-rays are inconclusive. MRI also frequently identifies other causes of hip pain and disability in patients with suspected fractures.
Area of Science:
- Orthopedic diagnostics
- Medical imaging techniques
Background:
- Conventional radiography is standard for proximal femur fractures.
- Magnetic resonance imaging (MRI) is considered when radiographs are negative or equivocal, yet clinical suspicion for fracture persists.
Purpose of the Study:
- To evaluate the utility of MRI in diagnosing occult hip fractures.
- To determine if MRI can identify alternative diagnoses in patients with persistent clinical suspicion of hip fracture.
Main Methods:
- A prospective study included 100 patients with negative or equivocal radiographs and clinical suspicion of hip fracture.
- Patients underwent MRI between November 1998 and December 2001.
- Interobserver agreement among radiologists was assessed.
Main Results:
- MRI identified femoral neck or intertrochanteric fractures in 46 patients and other fractures in 27.
- MRI revealed other findings in 18 patients and was negative in 10 (one false negative).
- High interobserver agreement was noted among experienced radiologists (kappa=0.78).
Conclusions:
- MRI is a valuable tool for detecting occult hip fractures.
- When a hip fracture is absent, MRI often provides an alternative explanation for patient symptoms.
Related Concept Videos
01:24Magnetic Resonance Imaging
01:14Imaging Studies I: CT and MRI
Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...