In one study of 36 patients, impaired femoral head perfusion was more common in patients with displaced fractures, although there was considerable overlap of perfusion pattern and fracture type [44]. The accuracy of predicting successful osseous union was 75% based on fracture morphology and improved incrementally to 89% on the basis of perfusion dynamics. Only 2 of 16 patients with nondisplaced fractures had osteonecrosis. A study from 2009 had similar results with 90% accuracy for prediction of successful fracture union on the basis of femoral head perfusion [45]. However, the study identified only 1 patient with a nondisplaced fracture with impaired femoral head perfusion and did not specify whether this patient went on to osteonecrosis, nor was the accuracy of predicting osteonecrosis on the basis of femoral head perfusion compared to that of the well-established Garden classification system. Given these findings, it is not clear if contrast-enhanced MRI offers significant advantages in the evaluation of the fractured hip compared to existing classification systems. CT Pelvis and Hips CT has advantages over MRI in terms of speed as well as use in patients with significant confusion. There has been considerable investigation into the accuracy of noncontrast CT for detection of radiographically occult proximal femoral fractures, although these studies have been invariably retrospective in nature, have used inconsistent methodology, and at times produced conflicting results. In one study of 199 patients, CT was negative for fracture in 93 patients, and none were found to have undiscovered fractures at 4-month clinical follow-ups [34]. Another similar study with 68 patients found no missed fractures in 27 patients with negative CT scans, although it was not clear if clinical follow-up was as comprehensive [46]. However, a number of other studies have demonstrated potential limitations in the sensitivity of CT.
Acute Hip Pain Suspected Fracture PCAs. In one study of 36 patients, impaired femoral head perfusion was more common in patients with displaced fractures, although there was considerable overlap of perfusion pattern and fracture type [44]. The accuracy of predicting successful osseous union was 75% based on fracture morphology and improved incrementally to 89% on the basis of perfusion dynamics. Only 2 of 16 patients with nondisplaced fractures had osteonecrosis. A study from 2009 had similar results with 90% accuracy for prediction of successful fracture union on the basis of femoral head perfusion [45]. However, the study identified only 1 patient with a nondisplaced fracture with impaired femoral head perfusion and did not specify whether this patient went on to osteonecrosis, nor was the accuracy of predicting osteonecrosis on the basis of femoral head perfusion compared to that of the well-established Garden classification system. Given these findings, it is not clear if contrast-enhanced MRI offers significant advantages in the evaluation of the fractured hip compared to existing classification systems. CT Pelvis and Hips CT has advantages over MRI in terms of speed as well as use in patients with significant confusion. There has been considerable investigation into the accuracy of noncontrast CT for detection of radiographically occult proximal femoral fractures, although these studies have been invariably retrospective in nature, have used inconsistent methodology, and at times produced conflicting results. In one study of 199 patients, CT was negative for fracture in 93 patients, and none were found to have undiscovered fractures at 4-month clinical follow-ups [34]. Another similar study with 68 patients found no missed fractures in 27 patients with negative CT scans, although it was not clear if clinical follow-up was as comprehensive [46]. However, a number of other studies have demonstrated potential limitations in the sensitivity of CT.