Does the Use of Magnetic Resonance Imaging Scan in Occult and Suspected Metastatic Pathological Neck of Femur Fractures Affect the Choice of Surgical Intervention?

Abstract

Background: Magnetic resonance imaging (MRI) is often employed as the diagnostic modality of choice in occult and suspected pathological femoral neck fractures. We evaluated the clinical utility of MRI scan in this patient population. Method: Retrospective observational analysis of cases with a radiologically occult or suspected metastatic pathological neck of femur fracture. Results: From a total of 894 femoral neck fractures treated in our institution, 100 patients had and MRI scan pre-operatively for either occult fracture or suspected fracture secondary metastatic disease. Magnetic resonance imaging confirmed the presence of 13 simple fractures. A total of 14 patients had pathological features suggestive of metastasis, of which 12 were clearly visible on plain radiographs. Surgical plan did not change after MRI for any of these pathological fractures. Conclusion: Results of this study demonstrate that an MRI scan had an impact on treatment selection only when a simple but radiographically occult fracture is suspected and but not in the context of suspected metastatic pathological fractures.