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RadioGraphics, Vol 9, 407-436, Copyright © 1989 by Radiological Society of North America

ARTICLES

MRI demonstration of radiographically occult fractures: what have we been missing?

PE Berger, RA Ofstein, DW Jackson, DS Morrison, N Silvino and R Amador
Department of Radiology, Memorial Medical Center of Long Beach, California.

During the course of MRI examinations of the knee for possible internal derangement, the hip for avascular necrosis, and the shoulder for rotator cuff tears, we have encountered many examples of unsuspected fractures of the tibial plateau, femoral condyles, pelvis, hip and proximal humerus. These fractures were either radiographically inapparent or demonstrated very subtle abnormalities that were missed on prospective interpretation. In addition, a large number of patients have been found to demonstrate evidence of intraosseous trabecular disruption, or edema and hemorrhage of medullary bone, or stress type injuries, all of which are radiographically occult. The clinical significance of these osseous abnormalities varies and is dependent upon the degree of injury. It is believed that an awareness of these osseous abnormalities will improve the accuracy of MRI interpretation, will heighten an appreciation of the subtle radiographic abnormalities that may be present, and will improve patient evaluation and management.


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