What imaging is initial for suspected hip fracture when the patient cannot stand?

What imaging is initial for suspected hip fracture when the patient cannot stand?

• A. AP pelvis radiograph with a cross-table lateral view
• B. MRI hip
• C. CT pelvis
• D. Ultrasound hip

Answer: (D)

If a patient with suspected hip fracture cannot stand, the first imaging step is ultrasound of the hip because it can be done right at the bedside, immediately, and without moving the patient. This is valuable in unstable or non–ambulatory patients where transporting them for radiographs would delay care or pose risk. Ultrasound is fast, portable, and radiation-free, so you can quickly look for signs that support fracture or related pathology and begin appropriate management right away. Keep in mind that ultrasound is highly operator-dependent and not as sensitive as radiographs or MRI for detecting many fractures, especially nondisplaced neck fractures. It serves mainly as a rapid, initial assessment to guide immediate decisions and triage. If ultrasound findings are inconclusive or if clinical suspicion remains high, follow up with standard radiographs (typically an AP pelvis with a cross-table lateral) and, if needed, MRI to evaluate occult fractures. CT is another option when MRI isn’t available or when detailed fracture anatomy is required.

If a patient with suspected hip fracture cannot stand, the first imaging step is ultrasound of the hip because it can be done right at the bedside, immediately, and without moving the patient. This is valuable in unstable or non–ambulatory patients where transporting them for radiographs would delay care or pose risk. Ultrasound is fast, portable, and radiation-free, so you can quickly look for signs that support fracture or related pathology and begin appropriate management right away.

Keep in mind that ultrasound is highly operator-dependent and not as sensitive as radiographs or MRI for detecting many fractures, especially nondisplaced neck fractures. It serves mainly as a rapid, initial assessment to guide immediate decisions and triage. If ultrasound findings are inconclusive or if clinical suspicion remains high, follow up with standard radiographs (typically an AP pelvis with a cross-table lateral) and, if needed, MRI to evaluate occult fractures. CT is another option when MRI isn’t available or when detailed fracture anatomy is required.