Skeletal Radiology

, Volume 41, Issue 9, pp 1127–1132 | Cite as

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



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 fractures Hip MRI Coexisting pelvic ring Femoral neck fractures 


  1. 1.
    Verbeeten KM, Hermann KL, Hasselkvist KM, et al. The advantages of MRI in the detection of occult hip fractures. Eur Radiol. 2005;15:165–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Rubin SJ, Marquardt JD, Gottlieb RH, et al. Magnetic resonance imagining: a cost-effective alternative to bone scintigraphy in the evaluation of patients with suspected hip fractures. Skeletal Radiol. 1998;27:199–204.PubMedCrossRefGoogle Scholar
  3. 3.
    Cabarrus MC, Ambekar A, Lu Y, Link TM. MRI and CT of insufficiency fractures of the pelvis and proximal femur. Am J Roentgenol. 2008;191(4):995–1001.CrossRefGoogle Scholar
  4. 4.
    NICE clinical guideline 124. The management of hip fracture in adults.
  5. 5.
    Bogost GA, Lizerbram EK, Crues JV. MR imaging in evaluation of suspected hip fracture: frequency of unsuspected bone and soft-tissue injury. Radiology. 1995;197:263–7.PubMedGoogle Scholar
  6. 6.
    Cosker TDA, Ghandour A, Gupta SK, Tayton KJJ. Pelvic ramus fractures in the elderly: 50 patients studied with MRI. Acta Orthop. 2005;76:513–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Lakshmanan P, Sharma A, Lyons K, Peechal JP. Are occult fractures of the hip and pelvic ring mutually exclusive? J Bone Joint Surg Br. 2007;89-B:1344–6.CrossRefGoogle Scholar
  8. 8.
    Sankey RA, Turner J, Lee J, Healy J, Gibbons CER. The use of MRI to detect occult fractures of the proximal femur. A study of 102 consecutive cases over a ten-year period. J Bone Joint Surg Br. 2009;91-B:1064–8.CrossRefGoogle Scholar
  9. 9.
    Oka M, Monu JU. Prevalence and patterns of occult hip fractures and mimics revealed by MRI. Am J Roentgenol. 2004;182:283–8.Google Scholar
  10. 10.
    Pandey R, McNally E, Ali A, Bulstrode C. The Role of MRI in the diagnosis of occult hip fractures. Injury. 1998;29(1):61–3.PubMedCrossRefGoogle Scholar
  11. 11.
    Frihagen F, Nordsletten L, Tariq R, Madsen JE. MRI diagnosis of occult hip fractures. Acta Orthop. 2005;76(4):524–30.PubMedCrossRefGoogle Scholar
  12. 12.
    Chana R, Noorani A, Ashwood N, Chatterji U, Helay J, Baird P. The role of MRI in the diagnosis of proximal femoral fractures in the elderly. Injury. 2006;37:185–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Alam A, Willett K, Ostlere S. The MRI diagnosis and management of incomplete intertrochanteric fractures of the femur. J Bone Joint Surg Br. 2005;87-B:1253–5.CrossRefGoogle Scholar

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

Personalised recommendations