Full FDA Non-Device CDS disclaimer

ARKA Clinical Decision Support is designed to meet all four criteria for Non-Device CDS under FD&C Act §520(o)(1)(E) and FDA's January 2026 final guidance on Clinical Decision Support Software. Recommendations support, not replace, the clinician's judgment. Every recommendation is anchored in a published guideline or peer-reviewed source, with the basis available for independent review. CLIN emphasizes imaging appropriateness at order entry.

This recommendation is intended to support, not replace, clinical judgment. It is generated by ARKA, software designed to meet the four criteria for Non-Device Clinical Decision Support under FD&C Act §520(o)(1)(E) and FDA's final guidance on Clinical Decision Support Software (January 2026). The clinician is responsible for the final decision.

Regulatory rationale Feature catalog Trust center

Evidence library

AIIE Evidence

Suspected occult hip fracture with negative X-ray — MRI

Lower Extremity MSK

Last reviewed 2026-06-01

Knowledge Matrix v1.0.0

Clinical bottom line

Negative films + clinical suspicion (non-weight-bearing) → hip MRI within 24 hours; do not discharge on analgesia alone.

Summary

When a patient cannot bear weight after hip trauma but radiographs are normal, MRI is the definitive study for occult fracture — recommended within 24 hours by NICE. CT is the fallback when MRI is unavailable, accepting lower sensitivity for trabecular injury.

Key points

2–10% of hip fractures are radiographically occult.
Missed occult fractures displace, converting fixable injuries into arthroplasty cases.
Limited coronal MRI protocols answer the question quickly and cheaply.