Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword
- Preface
- Section 1 Shoulder
- Section 2 Arm
- Section 3 Elbow
- Section 4 Forearm
- Section 5 Wrist
- Section 6 Hand
- Section 7 Hip and Pelvis
- Case 45 Femoroacetabular impingement: cam- versus pincer-type
- Case 46 Snapping hip
- Case 47 Labral tear versus cleft versus labral recess
- Case 48 Transient bone marrow edema of the hip (transient osteoporosis) versus osteonecrosis
- Case 49 Hip fractures in the elderly
- Case 50 Insufficiency fractures of the pelvis
- Case 51 Mild-to-moderate acetabular maldevelopment in the adult hip
- Case 52 Calcific tendinitis of the hip
- Case 53 Hip arthroplasty: periprosthetic fracture in the femur
- Section 8 Thigh
- Section 9 Leg
- Section 10 Ankle
- Section 11 Foot
- Section 12 Tumors/Miscellaneous
- Index
- References
Case 49 - Hip fractures in the elderly
from Section 7 - Hip and Pelvis
Published online by Cambridge University Press: 05 July 2013
- Frontmatter
- Contents
- List of contributors
- Foreword
- Preface
- Section 1 Shoulder
- Section 2 Arm
- Section 3 Elbow
- Section 4 Forearm
- Section 5 Wrist
- Section 6 Hand
- Section 7 Hip and Pelvis
- Case 45 Femoroacetabular impingement: cam- versus pincer-type
- Case 46 Snapping hip
- Case 47 Labral tear versus cleft versus labral recess
- Case 48 Transient bone marrow edema of the hip (transient osteoporosis) versus osteonecrosis
- Case 49 Hip fractures in the elderly
- Case 50 Insufficiency fractures of the pelvis
- Case 51 Mild-to-moderate acetabular maldevelopment in the adult hip
- Case 52 Calcific tendinitis of the hip
- Case 53 Hip arthroplasty: periprosthetic fracture in the femur
- Section 8 Thigh
- Section 9 Leg
- Section 10 Ankle
- Section 11 Foot
- Section 12 Tumors/Miscellaneous
- Index
- References
Summary
Imaging description
The MRI appearance of a fracture is that of a linear or curvilinear focus of hypointensity on T1-weighted images that is either hyper- or hypointense on T2-weighted or STIR images (Figure 49.1). A limited MRI study with only coronal images is highly effective in ruling out a radiographically occult hip fracture in the elderly. Depending on the study, anywhere from 10–67% of hip fractures in the elderly seen on MRI are not visible on radiographs.
Importance
Between 10–67% of hip fractures in the elderly seen on MRI are not visible on radiographs. Early detection of occult hip fractures in the elderly has been shown to lower the risk of complications such as osteonecrosis, reduce the length of the hospital stay, and to reduce the overall cost for the patient. MRI can also demonstrate other causes of post-traumatic hip pain such as muscle strains, muscle ruptures, or pubic rami fractures (Figure 49.2).
Typical clinical scenario
An 80-year-old female presents to the emergency treatment center from an assisted living institution. Her caregiver reports that she is no longer ambulating. The patient does not remember any trauma or a fall. She describes some vague pain over the right hip. A radiograph was negative; however, an MRI demonstrated a basicervical hip fracture.
Teaching point
In an elderly patient with post-traumatic hip pain or in a patient that is a poor historian, MRI is used to rule out radiographically occult hip fractures to prevent unnecessary complications and potentially lower the overall morbidity.
- Type
- Chapter
- Information
- Pearls and Pitfalls in Musculoskeletal ImagingVariants and Other Difficult Diagnoses, pp. 104 - 105Publisher: Cambridge University PressPrint publication year: 2013