Review article: Magnetic resonance imaging and computed tomography in the diagnosis of occult proximal femur fractures.

Electronic databases of MEDLINE, EMBASE, CINAHL, and the Cochrane Library as well as the Google Scholar search engine were used. Studies written in the English language highlighting the use of magnetic resonance imaging (MRI) and computed tomography in diagnosing occult proximal femoral fractures despite negative or equivocal plain radiographs were included. Two reviewers independently extracted data from each article. Raw frequencies for each of the details investigated were calculated. 15 prospective and 7 retrospective studies from 1989 to 2009 were included in this systematic review. A total of 996 patients (mean age, 75 years; standard deviation, 5 years) with suspected occult proximal femur fractures underwent MRI for further assessment. 350 (35%) of the patients tested positive for proximal femoral fractures, of whom 295 (84%) underwent further treatment/surgical interventions. MRI also detected other fractures and soft-tissue injuries. MRI was superior to other imaging modalities in diagnosing occult proximal femoral fractures and should be performed within 24 hours of injury. Early diagnosis and management may avoid substantial displacement and complications, and improve overall mortality and morbidity.