Suspected radiographically occult hip fracture — MRCEM SBA MCQ

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EasyTraumaSuspected radiographically occult hip fractureMRCEM SBA

An 82-year-old woman attends the emergency department after a fall from standing height. She has persistent left groin pain, pain on passive rotation of the hip and cannot bear weight. She is haemodynamically stable. Adequate AP pelvis and lateral left hip radiographs show no fracture. CT of the hip is available now; the earliest MRI appointment is in 36 hours. What is the most appropriate next plan?

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Correct answer: B — Admit for analgesia and arrange hip CT now.

Her inability to bear weight, groin pain and pain on passive hip rotation sustain clinical suspicion of a hip fracture despite adequate negative radiographs. She needs analgesia and further imaging rather than being treated as having no fracture. NICE recommends offering MRI for suspected hip fracture after adequate negative X-rays; **if MRI is unavailable within 24 hours**, CT should be considered. With MRI delayed for 36 hours and CT available now, CT is the best next investigation. A is attractive because MRI is the preferred investigation when it can be obtained within 24 hours, but waiting 36 hours is unnecessary here. C would be appropriate if the initial radiographs were technically inadequate; these films are adequate, so repeating them now does not resolve the suspicion. D could assess a suspected hip effusion, but ultrasound is not the recommended investigation for an occult hip fracture. E is another potential method of investigating occult bone injury, but it does not supersede the available CT in this NICE pathway.

Reference: NICE CG124: Hip fracture: management — Imaging options in occult hip fracture (Last updated 6 January 2023) — https://www.nice.org.uk/guidance/cg124/chapter/Recommendations NICE CG124: Hip fracture: management — Analgesia (Last updated 6 January 2023) — https://www.nice.org.uk/guidance/cg124/chapter/Recommendations