Can a computed tomography (CT) scan of the abdomen and pelvis show a fractured hip?

CT Abdomen and Pelvis Can Detect Hip Fractures, But Is Not Optimal

A CT scan of the abdomen and pelvis can detect hip fractures, but it is not the optimal imaging modality for this purpose and may miss some fractures, particularly non-displaced ones. 1

Diagnostic Capability of CT Abdomen/Pelvis for Hip Fractures

Detection Capabilities

• CT abdomen and pelvis can visualize hip fractures, particularly when:
  • Bone algorithm reconstructions are performed 1
  • The fracture is displaced or has significant displacement
  • The scan includes the hip joints in the field of view

Limitations

• Sensitivity is significantly lower than dedicated imaging:
  • CT has shown sensitivity of only 69-87% for hip fractures compared to 99-100% for MRI 1
  • Multiple studies have demonstrated CT can miss fractures, particularly non-displaced femoral neck fractures 1, 2
  • One study found CT sensitivity of only 86% for occult hip fractures 2

Practical Considerations

• If a CT abdomen/pelvis has already been performed (often for trauma evaluation):
  • Bone algorithm reconstruction of the pelvis and hips should be requested 1
  • This can avoid performing a separate examination 1, 3
  • One study found abdominal CT acceptable for detecting pelvic fractures despite thicker sections 3

Optimal Imaging Algorithm for Hip Fracture Detection

1. Initial imaging: Standard radiographs (AP pelvis and cross-table lateral view of the hip) 4

   • Detects approximately 90% of proximal femoral fractures
   • Should always be performed first

2. If radiographs are negative but clinical suspicion remains high:

   • First choice: MRI without contrast (99-100% sensitivity) 4
   • Alternative if MRI contraindicated/unavailable: Dedicated CT of the hip 4

3. If CT abdomen/pelvis already performed:

   • Review with bone algorithm reconstructions 1
   • If negative but high clinical suspicion remains, proceed to MRI 2

Clinical Implications and Pitfalls

Critical Considerations

• Missed hip fractures lead to:
  • Increased complications
  • Longer hospital stays
  • Higher mortality rates 4
  • Delayed treatment and worse outcomes 4

Common Pitfalls

• Relying solely on CT abdomen/pelvis when clinical suspicion is high
• Not requesting bone algorithm reconstructions when reviewing CT abdomen/pelvis
• Failing to proceed to MRI when CT is negative but clinical suspicion remains high

Special Considerations

• CT abdomen/pelvis may be valuable in trauma settings where multiple injuries are suspected 1
• CT can help evaluate associated injuries (pelvic fractures, visceral injuries) 5, 6
• Modern multislice CT technology has improved detection capabilities compared to older CT scanners 7

In summary, while a CT abdomen and pelvis can detect hip fractures, its sensitivity is insufficient to rule out fractures when clinical suspicion is high. MRI remains the gold standard for detecting occult hip fractures after negative radiographs.