Fast Five Quiz: Can You Properly Address Hip Fractures?

James W. Pritchett, MD

Disclosures

May 20, 2016

X-ray films are always indicated to determine which type of fracture, if any, is present. Anteroposterior views of the pelvis and hip, as well as cross-table lateral x-ray films, are usually sufficient to evaluate potential fractures. Rotating the affected leg internally or externally can increase the sensitivity of these radiographs.

If the clinical picture is highly suggestive of a fracture or stress fracture, and the x-ray findings fail to demonstrate a fracture, then MRI, linear tomography, or bone scanning can be useful in defining otherwise imperceptible fractures. A bone scan displays a radiographically occult fracture 80% of the time 24 hours after an injury, and it also shows almost all fractures after 72 hours. Negative bone scan findings virtually exclude the diagnosis of a stress fracture.

MRI is able to show areas of decreased signal in the marrow of the involved bone soon after the injury. Because of the increased prevalence of bilateral involvement, consider performing imaging studies on the contralateral hip when a stress fracture is suggested.

For more on the imaging of hip fracture, read here.

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