Studies suggest around 1% of hip fractures are missed on plain X-ray. So as usual you must combine clinical  and radiological findings.

1. Clinically assess ALL falls for hip injury
2. NOT clinically excluded (e.g. hip pain, reduced ROM, not mobile) – X-Ray Hip + Pelvis
   • Hip fracture confirmed – treat as appropriate (#NoF guide-HERE)
   • NO hip fracture OR Pubic Rami – Assess & Document pain and mobility
     • Comfortable and back to former mobility  – Consider discharge
     • Unable to mobilise OR pain uncontrolled – Admit to MAU/Frailty  (for analgesia, physio assessment and potential for CT/MRI if suspicion of occult hip #)

 

CT/MRI for further investigation

• Not all of these patients will require further imaging – after a period of analgesia and physio assessment
• NICE recommend the use of MRI (unless contraindicated or delay >24hr)
• However more evidence is becoming available for the use of CT, esp. if MRI will present a significant delay

• NICE
• BestBet