If MRI is not available, which imaging modality can be used to evaluate occult hip fractures?

• A. CT
• B. Ultrasound
• C. Plain X-ray
• D. PET

Answer: (A)

When there’s a high clinical suspicion of a hip fracture but MRI isn’t available, CT imaging is the best alternative. CT translates bone anatomy into detailed images and can reveal subtle nondisplaced fractures that plain X-rays often miss in the acute setting. Thin-slice CT with bone-window settings (sometimes with 3D reconstructions) enhances detection of cortical disruption and fracture lines, making it more reliable for occult hip fractures than ultrasound or PET, and far more informative for bone injury than plain radiographs. If CT is negative but suspicion remains high, repeat imaging or obtain MRI when possible.