#NoF – Beware Occult Hip Fractures

Studies suggest around 1% of hip fractures are missed on plain X-ray. So as usual you must combine clinical  and radiological findings.

  1. Clinically assess ALL falls for hip injury
  2. 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 OR Pubic Rami – Assess & Document pain and mobility
      • Comfortable and back to former mobility  – Consider discharge
      • Unable to mobilise OR pain uncontrolled – Admit to MAU/Frailty  (for analgesia, physio assessment and potential for CT/MRI if suspicion of occult hip #)

 

CT/MRI for further investigation

  • Not all of these patients will require further imaging – after a period of analgesia and physio assessment
  • NICE recommend the use of MRI (unless contraindicated or delay >24hr)
  • However more evidence is becoming available for the use of CT, esp. if MRI will present a significant delay

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