Occult hip fractures in the elderly: a protocol for management

Delayed diagnosis of hip fractures has an incidence of 2–9% in the literature. The morbidity of occult hip fractures can be enormous if the condition is not diagnosed. There are both clinical and radiological methods of enhancing the chances of diagnosis of this condition. Pain on flexion, abduction and external rotation with inability to “straight leg raise” are suggestive. The key to diagnosing occult hip fractures, which are not evident on plain radiographs is by other radiological investigations. Studies have shown that bone scans have 93% sensitivity and 95% specificity. For greater sensitivity, a 72-h delay is advisable. This increases the morbidity and cost. Magnetic resonance imaging is more promising; 100% sensitivity reported. We propose a protocol for the management of occult hip fractures to reduce the morbidity and associated cost.