Related Experiment Video
Updated: Dec 15, 2025
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Use of Advanced Imaging for Radiographically Occult Hip Fracture in Elderly Patients: A Systematic Review and
Arya Haj-Mirzaian1, John Eng1, Ramin Khorasani1
1From the Russell H. Morgan Department of Radiology and Radiological Science, (A.H., J.E., P.T.J., S.D.) Department of Orthopaedic Surgery (A.S.L.), and High Value Practice Academic Alliance (A.H., A.S.R., P.T.J., S.D.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140D, Baltimore, MD 21287; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.K., S.E.S.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.S.R.); and Library of Evidence, Harvard Medical School, Boston, Mass (R.K., A.S.R.).
Elderly patients with suspected hip fractures often have occult fractures missed by initial X-rays. Advanced imaging like MRI is crucial for accurate diagnosis in these cases.
Area of Science:
- Radiology
- Orthopedic Surgery
- Geriatric Medicine
Background:
- The rate of surgically significant hip fractures missed by initial radiography in elderly patients with suspected fractures is not well-established.
- The diagnostic utility of advanced imaging modalities for these occult fractures requires comprehensive assessment.
Purpose of the Study:
- To determine the frequency of radiographically occult hip fractures in elderly patients.
- To identify patient subpopulations at higher risk for occult hip fractures.
- To evaluate the diagnostic performance of CT and bone scanning for occult hip fractures using MRI as the reference standard.
Main Methods:
- A systematic literature review of observational studies (inception to September 27, 2018) was conducted.
- Studies included elderly patients with clinical suspicion of hip fracture but no radiographic evidence of surgical fracture.
- Pooled analysis assessed occult fracture rates, diagnostic performance of CT and bone scanning, and strength of evidence (SOE).
Main Results:
- The frequency of radiographically occult surgical hip fracture was 39% in patients with no definite radiographic fracture and 92% in those with isolated greater trochanter fractures.
- Higher occult fracture rates were observed in patients aged ≥80 years (44%), those with equivocal radiographic reports (58%), and those with a trauma history (41%).
- CT and bone scanning showed comparable diagnostic performance (sensitivity 79% and 87%, respectively) for detecting occult hip fractures.
Conclusions:
- Elderly patients presenting with acute hip pain and negative or equivocal initial radiographs have a substantial frequency of occult hip fractures.
- Advanced imaging, particularly MRI, is clinically indicated for all such patients to ensure accurate diagnosis and timely management.
- Early and accurate diagnosis of occult hip fractures is critical for appropriate surgical intervention and patient outcomes.
