The role of MRI in the diagnosis of proximal femoral fractures in the elderly.

The diagnosis of an undisplaced hip fracture cannot always be made on plain radiographs alone. The use of MRI scanning in detecting occult hip fractures is well documented. However, no previous studies have suggested which specific patient group would benefit most from this investigation. Thirty-five patients with hip pain and normal plain radiographs underwent MRI scanning. Pathology was detected in 29 of the patients, of which 21 involved a neck of femur fracture. Patients were divided into two groups based on age. In patients over 70 years, pathology detected resulted in surgical intervention in 13 cases. This is in contrast with those below the age of 70 years, in whom no neck of femur fractures were found and no surgical intervention was indicated (p<0.001). We recommend that an MRI scan be performed on such patients, above 70 years of age. These are the patients in whom management is significantly altered due to the imaging process used.