932 - Detecting Occult Fragility Fractures: The Critical role of MRI in Post Acute Rehabilitation: A Case Report

Case Diagnosis: 93 year old male admitted to acute inpatient rehabilitation following a fall. Initial work up with CT of Thorax abdomen and pelvis revealed T6 vertebral body fracture.

Case Description:

Case Description:
During rehabilitation, the patient demonstrated persistent left leg pain with weight bearing, which limited functional progress. Initial workup—including femur X-ray, hip ultrasound, and CT of the hip—was negative. Due to ongoing pain despite negative imaging, an MRI of the hip was obtained, revealing nondisplaced insufficiency fractures of sacrum and left intertrochanteric femur.

Setting:
Acute inpatient rehabilitation unit providing daily physical and occupational therapy focused on mobility, transfers, and activities of daily living.

Assessment/

Results:
Orthopedic consultation recommended surgical intervention with left prophylactic Trochanteric femoral nail antirotation. The patient returned to acute rehabilitation post-procedure. Left hip pain improved significantly, particularly with weight bearing, allowing the patient to progress in mobility to a modified independent level.

Discussions: This case highlights the importance of MRI in elderly patients with persistent pain despite negative initial imaging, as MRI is more sensitive for detecting occult fractures, particularly in the hip joint. Physiatrist play a critical role in identifying subtle changes in function and pain during activities of daily living and mobility, which can prompt further diagnostic evaluation. Early detection enables timely adjustment of weight-bearing status and therapy goals, helping to minimize immobility-related complications such as deconditioning, additional injury, and loss of independence.

Conclusions: Rehabilitation medicine serves as a critical diagnostic checkpoint, where persistent pain prompts reevaluation and advanced imaging. Multidisciplinary collaboration between rehabilitation and diagnostic teams enables early identification of missed injuries, supports safe mobilization, and promotes improved functional recovery in elderly patients with fragility fractures.