skip to main content

Occult hip fracture — MSRA MCQ

Instant feedback + full explanation. One question, done properly.

HardMRIOccult hip fractureMSRA

An 83-year-old woman is assessed in the emergency department after falling sideways from standing height. She has severe right groin pain and cannot weight-bear. Her right leg is held slightly flexed and externally rotated. Passive internal rotation of the hip reproduces marked groin pain. She is neurovascularly intact. Anteroposterior pelvic and lateral hip radiographs, reviewed by a radiologist, show no fracture. She has an eGFR of 31 mL/min/1.73 m² and takes apixaban for atrial fibrillation. MRI of the hip can be performed within 8 hours. What is the most appropriate further imaging plan?

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

Reveal the answer and explanation

Correct answer: C — Arrange MRI of the hip now

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

This presentation maintains a high clinical suspicion of an occult hip fracture despite adequate negative radiographs: she has sustained a low-energy fall, has persistent groin pain provoked by hip rotation, and cannot weight-bear. NICE recommends MRI when hip fracture is suspected despite negative hip X-rays. MRI is available within 8 hours, so the exception permitting CT does not apply. Her CKD and apixaban use do not alter this imaging choice because investigation of an occult hip fracture uses non-contrast MRI. A is a historically used pathway for some occult fractures, but delays diagnosis, definitive management and mobilisation in a patient with a probable hip fracture. C is appropriate if MRI is contraindicated or unavailable within 24 hours, neither of which applies here. D may detect occult bony injury but is not the recommended first alternative in this pathway. E incorrectly treats negative plain films as excluding hip fracture; the clinical findings require further imaging rather than a trial of mobilisation.

Reference: NICE CG124: Hip fracture: management — Imaging options in occult hip fracture (2011; amended 2014; checked 15 August 2026) — https://www.nice.org.uk/guidance/cg124/chapter/recommendations