Skeletal Radiology

, Volume 41, Issue 9, pp 1127–1132

Radiographically occult femoral and pelvic fractures are not mutually exclusive: a review of fractures detected by MRI following low-energy trauma

  • Magdalena Szewczyk-Bieda
  • Naveena Thomas
  • Thomas Barry Oliver
Scientific Article

DOI: 10.1007/s00256-012-1362-0

Cite this article as:
Szewczyk-Bieda, M., Thomas, N. & Oliver, T.B. Skeletal Radiol (2012) 41: 1127. doi:10.1007/s00256-012-1362-0



The purpose of this study was to review the MRI examinations of a large group of low-energy trauma patients in whom pelvic MRI had detected radiographically occult fractures, in order to characterize prevailing fracture patterns and determine how often co-existing proximal femoral and pelvic fractures were observed.


All patients having pelvic MRI over 5 years were identified. Word-search software selected 269 MRI reports containing the term ‘fracture’. Further scrutiny identified 168 with diagnosis of fracture. MRI request and imaging record review identified 102 low-energy trauma cases that had MRI for clinical suspicion of fracture despite normal radiographs. Sixty-six cases were excluded for the following reasons: no expressed clinical suspicion of occult fracture; history suggesting high-energy trauma; skeletal co-morbidity hindering acute fracture identification; interval more than 2 weeks between radiographs and MRI. The 102 study MRI examinations, which employed a limited two-sequence protocol, were reviewed. Any fracture that had not been appreciated on radiographs was recorded and characterized as femoral, pelvic, or co-existing femoral and pelvic fractures.


The 102 study cases had a median age of 82 years. The median interval between pelvic radiographs and MRI was 3 days. MRI showed undiagnosed femoral fracture in 48/102 cases (47.1%), sacral fracture in 41/102 (40.2%), and pubic fracture in 55/102 (53.9%). In 11/102 cases (10.8%), MRI showed undiagnosed fractures of both proximal femur and pelvic ring (seven sacral, six pubic bone, two other site fractures). In 10/11 cases with co-existing femoral and pelvic fractures, the femoral fracture was incomplete.


Limited pelvic MRI found a high prevalence of radiographically occult femoral and pelvic fractures in low-energy trauma patients, with clinical suspicion of fracture despite normal radiographs. Co-existing occult femoral and pelvic ring fractures were commonly observed, and in such cases, the femoral fracture was likely to be incomplete and multiple pelvic fractures were typically present.


Occult hip fracturesHip MRICoexisting pelvic ringFemoral neck fractures

Copyright information

© ISS 2012

Authors and Affiliations

  • Magdalena Szewczyk-Bieda
    • 1
  • Naveena Thomas
    • 1
  • Thomas Barry Oliver
    • 1
  1. 1.Department of Clinical RadiologyNinewells Hospital and Medical SchoolDundeeUK