• Rhys W Thomas, Huw L M Williams, Eleanor C Carpenter, and Kathleen Lyons.
• 1 Radiology and Trauma and Orthopaedics Departments, University Hospital of Wales, Heath Park Cardiff, UK.
• Br J Radiol. 2016 Jan 1; 89 (1060): 20150250.

Objective10% of all hip fractures are occult on plain radiography, requiring further investigation to ascertain the diagnosis. MRI is presently the gold standard investigation, but frequently has disadvantages of time delay, resulting in increased hospital stay and mortality. Our aim was to establish whether multidetector CT (MDCT) is an appropriate first-line investigation of occult femoral neck (NOF) fractures.MethodsFrom 2013, we elected to use MDCT as the first-line investigation in patients believed to have an NOF fracture with negative plain films. These were reported by consultant musculoskeletal radiologists. We retrospectively analysed the data of consecutive patients presenting to the University Hospital of Wales, over 30 months with a clinical suspicion of a hip fracture.Results1443 patients were admitted during the study period. 209 (14.5%) patients had negative plain films requiring further investigation to exclude an NOF fracture, of which 199 patients had a CT. 93 patients had no fracture and 20 patients had isolated greater trochanter fractures. None of these patients progressed to develop an intracapsular femoral neck fracture at 4-month follow-up, although one patient sustained an extracapsular fracture following a high-energy fall whilst admitted. 26 femoral neck fractures were diagnosed on CT, whilst the remaining 60 patients were diagnosed with other pelvic ring fractures.ConclusionWhen interpreted by experienced radiologists, MDCT has both sensitivity and specificity of 100%.Advances In KnowledgeWe recommend the use of MDCT as a safe and appropriate first-line investigation for NOF fractures.

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