• Jesse Cannon, Salvatore Silvestri, and Mark Munro.
• Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida 32806, USA.
• J Emerg Med. 2009 Aug 1;37(2):144-52.

BackgroundHip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people.ObjectivesIn this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality.DiscussionPlain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3-4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging.ConclusionWe present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.

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