A proportion of femoral neck fractures are not visible on the first radiographs. An older adult who has fallen, has hip pain and cannot bear weight should have further imaging if the films are normal, rather than being discharged on the radiograph alone.
MRI is the most sensitive test and also shows other causes of pain such as pubic ramus or sacral fractures; CT is a reasonable alternative where MRI is not quickly available, although it is less sensitive for undisplaced fractures in osteoporotic bone.
- Arrange MRI when hip pain and inability to bear weight persist after a normal radiograph.
- Use CT if MRI is not available promptly, recognising its lower sensitivity in osteoporotic bone.
- Look for pubic ramus and sacral fractures when the femoral neck is intact.
- Document the clinical concern on the request so the scan is prioritised.
Why it matters
A missed undisplaced fracture can displace and turn a fixation into a replacement.
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