Imaging description

The MRI appearance of a fracture is that of a linear or curvilinear focus of hypointensity on T1-weighted images that is either hyper- or hypointense on T2-weighted or STIR images (Figure 49.1). A limited MRI study with only coronal images is highly effective in ruling out a radiographically occult hip fracture in the elderly. Depending on the study, anywhere from 10–67% of hip fractures in the elderly seen on MRI are not visible on radiographs.

Importance

Between 10–67% of hip fractures in the elderly seen on MRI are not visible on radiographs. Early detection of occult hip fractures in the elderly has been shown to lower the risk of complications such as osteonecrosis, reduce the length of the hospital stay, and to reduce the overall cost for the patient. MRI can also demonstrate other causes of post-traumatic hip pain such as muscle strains, muscle ruptures, or pubic rami fractures (Figure 49.2).

Typical clinical scenario

An 80-year-old female presents to the emergency treatment center from an assisted living institution. Her caregiver reports that she is no longer ambulating. The patient does not remember any trauma or a fall. She describes some vague pain over the right hip. A radiograph was negative; however, an MRI demonstrated a basicervical hip fracture.

Teaching point

In an elderly patient with post-traumatic hip pain or in a patient that is a poor historian, MRI is used to rule out radiographically occult hip fractures to prevent unnecessary complications and potentially lower the overall morbidity.