skip to main content

Suspected occult hip fracture — MRCEM SBA MCQ

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

EasyProcedures, imaging and diagnosticsSuspected occult hip fractureMRCEM SBA

An 82-year-old woman presents after a fall from standing. Despite analgesia, she has persistent left groin pain, marked pain on passive hip rotation and cannot bear weight. Adequate anteroposterior pelvis and lateral left hip radiographs show no fracture. She is haemodynamically stable and has no MRI contraindication. CT is available immediately; MRI is available in six hours. What is the most appropriate imaging and disposition plan?

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

Reveal the answer and explanation

Correct answer: D — Arrange MRI of the hip within 24 hours and admit for orthopaedic assessment.

The negative radiographs do not resolve the diagnosis: after a fall, persistent groin pain, pain on hip rotation and inability to bear weight despite analgesia leave a clinically important suspicion of an occult hip fracture. NICE recommends MRI when hip fracture remains suspected despite adequate negative radiographs. Because MRI is available in six hours and is not contraindicated, arrange it within 24 hours. She should remain in hospital for assessment rather than be treated as having a simple soft-tissue injury. ([nice.org.uk](https://www.nice.org.uk/guidance/cg124/chapter/recommendations)) **A** is attractive because CT can be performed sooner, but NICE positions CT as an alternative when MRI is contraindicated or unavailable within 24 hours. **B** reflects a traditional strategy for detecting fractures that become visible later; it delays diagnosis when MRI is accessible. **C** selects the preferred modality but introduces an unnecessary 48-hour delay. **E** is an alternative imaging technique, but early bone scintigraphy is less suitable than the available MRI for this decision. ([nice.org.uk](https://www.nice.org.uk/guidance/cg124/chapter/recommendations))

Reference: NICE CG124, Hip fracture: management, recommendation 1.1.1 (6 January 2023) — https://www.nice.org.uk/guidance/cg124/chapter/recommendations NICE CG124, full guideline: imaging options in occult hip fracture (6 January 2023) — https://www.nice.org.uk/guidance/cg124/evidence/full-guideline-183081997 University Hospitals Bristol and Weston NHS Foundation Trust, Management of Hip Femoral Fragility Fracture patients (2024) — https://www.uhbw.nhs.uk/assets/1/25-508_uhbw_ubht1147_hip_fracture_2024_final_version_2_redacted.pdf