What is the role of imaging studies in the workup of hip fractures?

Updated: Jan 08, 2019
  • Author: Naveenpal S Bhatti, MD; Chief Editor: Sherwin SW Ho, MD  more...
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  • In addition to the recommended laboratory studies in a patient suspected of having a hip fracture, the physician should also obtain a chest x-ray film and an electrocardiogram (ECG) tracing to further assess the patient's medical condition before any surgical intervention.

  • X-ray films are always indicated to determine which type of fracture, if any, is present. Anteroposterior (AP) views of the pelvis and hip and 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. See the images below.

    Anteroposterior view of the pelvis with a displace Anteroposterior view of the pelvis with a displaced femoral neck fracture.
    Lateral view of a displaced femoral neck fracture. Lateral view of a displaced femoral neck fracture.
  • If the clinical picture is highly suggestive of a fracture or stress fracture and the x-ray findings fail to demonstrate a fracture, magnetic resonance imaging (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.

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