UMEM Educational Pearls

Category: Orthopedics

Title: Hip Fractures

Keywords: hip, fracture, mri, plain films (PubMed Search)

Posted: 6/21/2008 by Michael Bond, MD (Updated: 6/13/2024)
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Hip Fractures:

Typically divided into four types:

  1. Intracapsular,
    1. femoral head and neck fractures
  2. Extracapsular
    1.  trochanteric,
    2. Intertrochanteric
    3. subtrochanteric fractures. 
  • Non-displaced fractures, especially in osteoporotic elderly patients, may be missed on plain films. This is estimated to occur in 2-9% of cases. 
  • It can take up to 72 hours for a fracture to be seen on bone scan. And it is estimated that only 80% of fractures will be seen at 24 hours.
  • MRI is now the preferred imaging modality (100% sensitivity and specificity) to confirm a hip fracture when plain films are negative and equivocal. A MRI will have positive findings in as little as 4 hours after a fracture.
  • Consider CT scan of the hip if MRI is not available at your center.

Here is a link to a picture with a good representation of the different types of fractures.

References

Perron A.D., Miller M.D., Brady W.J. Orthopedic pitfalls in the ED: Radiographically occult hip fracture. Am J Emerg Med 2002;20:234-237.