X-ray imaging of the hip and pelvis can miss acute fractures. In a retrospective study to determine the accuracy of radiography, Duke University researchers identified 92 consecutive patients (mean age, 71) who received hip or pelvis x-rays in the emergency department and then underwent hip or pelvis magnetic resonance imaging (MRI) within 1 day. Falls and motor vehicle trauma were the usual indications for radiography. Key findings were as follows:
In 13 patients with normal x-rays, MRI revealed 6 fractures of the hip and 17 fractures of the pelvis.
In 11 of 26 patients whose x-rays suggested fractures, MRI showed no fractures.
In 7 of the 15 patients whose MRIs confirmed fractures found on x-rays, MRI also identified second fractures that x-ray imaging missed.
Comment: Although the manner in which these cases were selected precludes a precise estimate of sensitivity and specificity of conventional x-rays for detecting acute hip and pelvis fractures, the study results suggest that both false-positives and false-negatives are not uncommon. However, these findings do not mean that MRI is necessary in all cases; x-rays should be followed by MRI only when a chance exists that MRI will change management.
— Allan S. Brett, MD
Published in Journal Watch General Medicine April 22, 2010
Dato' Dr. Ismail Yaacob
Medical Director/Consultant Physician
Kedah Medical Centre
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