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Occult hip fracture — SCE Geriatric Medicine MCQ

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HardOrthogeriatricsOccult hip fractureSCE Geriatric Medicine

A 90-year-old on apixaban cannot straight-leg raise after a fall and has pain on passive hip rotation. Pelvic radiographs are normal, but haemoglobin has fallen 16 g/L. What is the next diagnostic step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Obtain urgent magnetic-resonance imaging of the symptomatic hip and pelvis

Explanation lettering: E = shown as A · A = shown as B · B = shown as D · D = shown as E

A is correct: persistent clinical suspicion after normal radiographs requires MRI; CT is the alternative if MRI is unavailable within 24 hours or contraindicated. B and C risk displacement and delayed treatment of an occult fracture. D creates delay and stopping apixaban does not make diagnostic imaging unsafe. E addresses future fracture risk, not the acute diagnosis.

Reference: NICE CG124: hip fracture management: https://www.nice.org.uk/guidance/cg124/chapter/recommendations