MRI better than X-Ray for some traumatic hip fractures

MRI reveals that greater trochanteric fractures of the hip that are diagnosed as isolated on X-ray are frequently underestimated and are neither isolated nor minor, say a pair of researchers from Presbyterian Hospital, New York, NY.

Frieda Feldman, MD, and Ronald B. Staron, MD, analyzed 37 patients over the age of fifty who had fallen and fractured their hip. All patients were diagnosed on X-ray as having greater trochanteric fractures, an injury to one of the bony protrusions near the upper part of the femur, and had follow-up MRI performed. MRI revealed more extensive fractures in 35 of the patients than the X-rays had.

According to the study, this type of fracture, usually the result of a fall, is often found in elderly patients, and X-ray is one of the standard imaging techniques performed for such an injury. “Routine X-ray imaging, in my view, is still the indispensable primary technique for imaging hip trauma. However, although X-rays may reveal greater trochanteric fractures, they do not demonstrate their full geographic extent,” said Dr. Feldman.

Being able to fully gauge the scope of the injury allows for better treatment planning, say the researchers. “While isolated greater trochanteric fractures, as defined on X-ray, have been classically treated by bed rest or limited weight bearing, the potential clinical importance of MRI lies in furnishing physicians with documentation of all the ramifications of the fracture so that more informed decisions may be made as to surgical versus nonsurgical treatment in individual cases,” said Dr. Feldman.