Occult hip fractures: should magnetic resonance imaging be the first-line investigation following negative radiographs? A case report

Fragility fractures of the hip can be occult and undetected on plain radiographs.This results in delayed or missed diagnosis and treatment and thus poorer outcomes.We describe a case of 3-day delay in hip fracture treatment in an 85-year-old woman who presented with severe right hip pain without a history of trauma.Initial plain radiographs and computed tomography did not detect a hip fracture, but subsequent magnetic resonance imaging on day 3 detected an insufficiency fracture of the femoral neck.This case highlights the importance of using magnetic resonance imaging as the first-line investigation for hip pain in patients with clinical suspicion of fracture but with normal radiographs.