X-rays fail to spot up to nearly a third of fractures in the bones of the hip¹ and pelvis, research suggests.

研究显示，将近三分之一的臀部和骨盆骨伤不能通过X射线检测出来。

Less obvious fractures may be missed on normal X-rays

US doctors from Duke University warn that relying on standard X-rays alone to give a clean bill of health（健康证明书） could lead to wrong diagnoses and law suits.

When they re-checked the X-ray results of 92 patients using a more detailed² scanner, called MRI（核磁共振成像） , they found 35 fractures that had been missed.

The findings are published in the American Journal of Roentgenology（X光线学） .

Dr Charles Spritzer, who led the research, said: "The diagnosis³ of traumatic（外伤的，创伤的） fracture most often begins and ends with X-rays of the hip, pelvis（骨盆） , or both.

"In some cases though, the exclusion⁴（排斥，排除） of a traumatic fracture is difficult."

Delayed diagnosis

In the study of patients complaining of pain after an injury to the hip or pelvis, 13 with normal X-ray findings were found to have a collective total of 23 fractures seen on MRI (magnetic resonance⁵ imaging).

Another 15 patients with abnormal X-rays had 12 additional pelvic fractures seen on MRI that otherwise would not have been identified.

And in 11 patients, MRI showed no fracture after X-rays had suggested there might be one.

The researchers say it is worth using MRI as well as an X-ray if doctors are in any doubt, particularly since hip patients tend to be frail⁶（虚弱的） and elderly with a higher than average risk of complications and death.

Dr Spritzer said: "Accurate diagnosis of hip and pelvic fractures in the emergency department can speed patients to surgical⁷ management, if needed, and reduce the rate of hospital admissions among patients who do not have fractures.

"Use of MRI in patients with a strong clinical suspicion of traumatic injury but unimpressive X-rays has a substantial advantage in the detection of pelvic and hip fractures."

Dr Tony Nicholson, from the Royal College of Radiologists, said the findings quantified something already known or suspected.

But he did not think it would be feasible（可行的，可能的） or sensible to give every patient an MRI scan.

"Ultimately, it comes down to clinical acumen⁸（聪明，敏锐） . If an elderly patient has persistent⁹ pain（顽痛，持续性痛） even though their X-ray shows only minor¹⁰ arthritis¹¹（关节炎） , an MRI would be a very reasonable request to check that there is not a fracture（骨折，破裂） .

"It is always worrying when something is not diagnosed immediately, but I think most clinicians are first class and would follow up a patient appropriately."