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A 2020 meta-analysis attempted to estimate the frequency of radiographically occult hip fractures in the elderly population.
26 studies evaluated the rate of surgical hip fractures with no obvious findings on plain film.
Median age 80.3 years (67-82 years).
MRI used as gold standard.
The overall rate of radiographically occult hip fracture requiring surgery was 39%.
This percentage is higher than reported in other studies which may have included non-elderly patients, retrospective bias or other issues.
Overall, 18% had femoral neck fractures, 17% had intertrochanteric fractures and 1% had subtrochanteric fractures.
Elderly patients with acute hip pain and negative or equivocal findings with initial plain film imaging have a high frequency of occult hip fractures. Strongly consider advanced imaging in this population