MRI Pelvis and Affected Hip There is considerable literature regarding the use of noncontrast MRI for the detection of radiographically occult proximal femoral fractures. An early study by Quinn et al [37] found MRI to be 100% accurate for fracture detection in patients with indeterminate radiographs using clinical outcomes as the gold standard. A subsequent study by Pandey et al [38] found no missed fractures in 10 of 33 patients with negative MRIs, all of whom were followed clinically for at least 6 months. A 2008 study showed 99% sensitivity of MRI, both for proximal femoral fractures and fractures of the pelvis [39]. With multiple studies indicating near 100% sensitivity for proximal femoral fracture, it has been suggested that a negative MRI may allow for confident discharge from the emergency department and reduce the number of cautionary admissions [23,29]. Conversely, rapid diagnosis of surgical fractures reduces delay to treatment with associated improved outcomes [10]. Several additional studies have also shown high diagnostic accuracy for diagnosis of both pelvis fractures and soft-tissue injuries in addition to fractures of the proximal femur [28,30,39]. This versatility is important as many series have shown a high incidence of extrafemoral trauma in patients with acute hip pain and negative radiographs. For example, in the study by Ohishi et al [30], of 113 patients, 38% had fractures of the proximal femur and 33% had fractures of the pelvis. In another retrospective series, Dominguez et al [21] found pelvic fractures to be more common than proximal femur fractures in this patient population, emphasizing the importance of accuracy in the assessment of extrafemoral trauma. Although many of these pelvic fractures and soft-tissue injuries may not be treated surgically, correct diagnosis allows for appropriate conservative treatment, including protected weight-bearing, pain control, deep vein thrombosis prophylaxis, and skilled rehabilitation.
Acute Hip Pain Suspected Fracture PCAs. MRI Pelvis and Affected Hip There is considerable literature regarding the use of noncontrast MRI for the detection of radiographically occult proximal femoral fractures. An early study by Quinn et al [37] found MRI to be 100% accurate for fracture detection in patients with indeterminate radiographs using clinical outcomes as the gold standard. A subsequent study by Pandey et al [38] found no missed fractures in 10 of 33 patients with negative MRIs, all of whom were followed clinically for at least 6 months. A 2008 study showed 99% sensitivity of MRI, both for proximal femoral fractures and fractures of the pelvis [39]. With multiple studies indicating near 100% sensitivity for proximal femoral fracture, it has been suggested that a negative MRI may allow for confident discharge from the emergency department and reduce the number of cautionary admissions [23,29]. Conversely, rapid diagnosis of surgical fractures reduces delay to treatment with associated improved outcomes [10]. Several additional studies have also shown high diagnostic accuracy for diagnosis of both pelvis fractures and soft-tissue injuries in addition to fractures of the proximal femur [28,30,39]. This versatility is important as many series have shown a high incidence of extrafemoral trauma in patients with acute hip pain and negative radiographs. For example, in the study by Ohishi et al [30], of 113 patients, 38% had fractures of the proximal femur and 33% had fractures of the pelvis. In another retrospective series, Dominguez et al [21] found pelvic fractures to be more common than proximal femur fractures in this patient population, emphasizing the importance of accuracy in the assessment of extrafemoral trauma. Although many of these pelvic fractures and soft-tissue injuries may not be treated surgically, correct diagnosis allows for appropriate conservative treatment, including protected weight-bearing, pain control, deep vein thrombosis prophylaxis, and skilled rehabilitation.