Justifying CT prior to MRI in cases of suspected occult hip fracture. A proposed diagnostic protocol

•In our study the majority of occult hip fractures were diagnosed via CT. Whilst CT is less sensitive than MRI for diagnosis of occult hip fracture, it can be used as a first line modality where MRI isn't readily available.•In our institute cost analysis of the proposed diagnostic protocol (selective MRI protocol) demonstrated lower overall costs than performing MRI in all patients.•In this study CT missed 12 occult hip fractures, which were diagnosed by subsequent MRI. All the missed fractures required operative treatment. This demonstrates that CT alone is not adequate where occult hip fracture is suspected.