Occult intertrochanteric fracture

Case contributed by Michael P. Hartung
Diagnosis certain

Presentation

Left hip pain after a fall.

Patient Data

Age: 85
Gender: Male

Day 1

x-ray
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Info

Subtle fragmentation about the greater trochanter. Subtle lower intertrochanteric lucency. No displaced fracture. 

Day 150

mri
This study is a stack
Coronal
PD
This study is a stack
Coronal T2
fat sat
This study is a stack
Axial T2
fat sat
This study is a stack
This study is a stack
Axial PD
fat sat
This study is a stack
Coronal
T1
This study is a stack
Coronal
STIR
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Info

Nondisplaced intertrochanteric fracture evidenced by T1 hypointense fracture line and T2 hyperintense oedema. 

Case Discussion

Subtle radiographic findings of fracture were not noticed on the initial read.

The patient continued to have pain and underwent MRI, showing a nondispalced interterchanteric fracture. In retrospect, subtle fragmentation of the greater trochanter and fine intertrochanteric lucency can be appreciated. 

MRI findings of injury are much more striking, and highlight the value in patients with suspected nondisplaced fracture. 

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