Hip Fracture: AI-Powered Imaging Analysis

Hip fractures are divided anatomically into femoral neck fractures and intertrochanteric or subtrochanteric fractures. Femoral neck fractures are further classified by the Garden classification (stages I–IV based on displacement) or the Pauwels classification (types I–III based on fracture line angle). Displacement is the primary driver of treatment: non-displaced femoral neck fractures (Garden I–II) in physiologically young patients are managed with internal fixation using cannulated screws or dynamic hip screws, whereas displaced fractures carry high avascular necrosis and non-union rates, prompting hemiarthroplasty or total hip arthroplasty in most patients over 65. Intertrochanteric fractures, which have a more robust blood supply, are almost universally treated with fixation using a sliding hip screw or intramedullary nail.

In patients presenting with groin pain after a fall whose plain radiographs are normal or equivocal, MRI is the modality of choice to detect occult hip fractures. MRI identifies bone marrow edema and a low-signal fracture line on T1-weighted sequences within 24 hours of injury, with near 100% sensitivity. CT offers better cortical detail and is faster and more widely available but misses up to 10–20% of non-displaced fractures that are invisible on plain films. MRI also avoids ionizing radiation — an advantage in younger patients — and simultaneously evaluates soft-tissue structures. When MRI is contraindicated, CT is an acceptable alternative; bone scintigraphy is rarely used today but remains an option when neither is available acutely.

Evidence consistently shows that surgical fixation or arthroplasty performed within 24 to 48 hours of admission is associated with lower rates of mortality, pulmonary embolism, pressure ulcers, and pneumonia compared with delayed surgery. Prolonged bed rest in elderly patients accelerates deconditioning and increases thromboembolic risk despite anticoagulation. Medical optimization — addressing anemia, anticoagulant reversal, cardiac evaluation, and electrolyte correction — should proceed rapidly in parallel with surgical planning rather than serially. Hip fracture programs with dedicated pathways targeting surgery within 24 hours have demonstrated meaningful reductions in 30-day and 1-year mortality across multiple health systems.