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Aim: There is an increasing incidence of hip fracture with associated morbidity and mortality making accurate and timely diagnosis essential. The aim of this study was to compare computed tomography (CT) and magnetic resonance imaging (MRI) to ascertain the optimum second-line investigation in cases where plain radiograph is not diagnostic. Material and Methods: Using the radiology information system, a total of 168 patients were identified with the suspected occult neck of femur fractures over 24 months who had undergone CT or MRI as second-line investigation. All relevant imaging was reviewed and diagnosis, any third-line or follow-up imaging was documented. Results: About 16% of patients undergoing CT as second-line test had proven originally occult femoral neck fractures on plain radiograph compared with 13% of those having MRI. About 13% of patients underwent MRI following CT and in 1/13 case MRI detected an occult fracture that had not been detected on CT. The remaining 11 patients were either negative or MRI proved CT suspicions of fracture when extra diagnostic certainty was requested by the surgeons. CT detected more non femoral pelvic fractures 47% versus 37%. Conclusion: CT and MRI are comparable at detecting occult femoral neck fractures. Given the increased availability, improved patient tolerance and speed of CT imaging, we advocate its use as the main second-line imaging modality. MRI remains a valuable problem-solving tool in a select few cases following review with a musculoskeletal radiologist.

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Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) is an acronym which encompasses SAPHO. SAPHO is a distinct clinical syndrome which involves the musculoskeletal and dermatological systems. The clinical presentation can be variable, and therefore, patients may present to non-specialists who are not familiar with the disease. It is, therefore, important for the radiologist to be aware of the imaging manifestations of SAPHO; as often, it is them who are the first to propose the diagnosis. Imaging allows differentiation of SAPHO from other disease processes such as inflammatory arthropathy, infection, and malignancy which can share similar features and also to demonstrate potentially subclinical areas of disease involvement. Treatment is empirical and aimed at symptom control and modifying the inflammatory process. Nonsteroidal anti-inflammatory drugs are the first-line agents. The disease has a good long-term prognosis, despite the challenges in diagnosis and treatment.

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