Studies suggest around 1% of hip fractures are missed on plain X-ray. So as usual you must combine clinical and radiological findings.
- Clinically assess ALL falls for hip injury
- NOT clinically excluded (e.g. hip pain, reduced ROM, not mobile) – X-Ray Hip + Pelvis
- Hip fracture confirmed – treat as appropriate (#NoF guide-HERE)
- NO hip fracture – Assess & Document pain and mobility
- Comfortable and back to former mobility – Consider discharge
- Clinical suspicion of hip fracture – Admit to frailty (for analgesia, physio assessment and potential for CT/MRI)
Not all of these patients will require further imaging – after a period of analgesia and physio assessment
What imaging? NICE recommend the use of MRI (unless contraindicated or delay >24hr) however more evidence is becoming available for the use of CT.