From the Guidelines
To evaluate a hip for fracture, typically two or three radiographic views are recommended, including an anteroposterior (AP) view of the pelvis and a lateral view of the affected hip, as this approach allows for better visualization and comparison of potential abnormalities to the contralateral asymptomatic side 1. The standard approach includes an AP view of the pelvis, which allows visualization of both hips for comparison and shows the femoral head, neck, and proximal femur.
- The AP view is essential for detecting fractures in the proximal femur and pelvis.
- The lateral view, which may be a cross-table lateral or a frog-leg lateral (if no fracture is suspected), provides perpendicular visualization to detect fractures not visible on the AP view.
- In some cases, an additional oblique view may be ordered to better visualize certain areas of the hip. These multiple views are necessary because fractures can be oriented in various planes, and a single view might miss a fracture that runs parallel to the X-ray beam 1. For elderly patients or those with significant trauma, CT scanning might be added if radiographs are negative but clinical suspicion remains high, as CT offers superior sensitivity for detecting subtle fractures, particularly in the acetabulum or femoral head 1. It is well established that patients with clinically suspected proximal femur fracture often have fractures of the pelvis, including the sacrum and pubic rami, and therefore, the radiographic series should include the AP view of the pelvis along with the orthogonal views of the symptomatic hip 1.
From the Research
Views for XR Hip to Diagnose Fractures
To diagnose hip fractures, several views can be used, including:
- Anteroposterior view of the pelvis 2, 3
- Cross-table lateral view of the hip 2, 3 These views are typically used in plain radiography to confirm the diagnosis of a hip fracture.
Occult Hip Fractures
If an occult hip fracture is suspected and plain radiography is normal, further imaging may be necessary, such as:
- Magnetic Resonance Imaging (MRI) 2, 3, 4, 5
- Computed Tomography (CT) scan 4, 5 MRI has been shown to be more accurate than CT scan for diagnosing occult hip fractures 4, but CT can be a valid first-line investigation 5.
Imaging Modalities
The choice of imaging modality depends on the clinical suspicion and the availability of resources.