Which imaging view is most commonly used initially to evaluate suspected hip fracture when leg weight-bearing is not possible?

Which imaging view is most commonly used initially to evaluate suspected hip fracture when leg weight-bearing is not possible?

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

Answer: (B)

When a hip fracture is suspected but the patient cannot bear weight, start with plain X-ray imaging of the pelvis and hip. An AP pelvis radiograph with a cross-table lateral view is the best initial combination because the AP view gives a broad picture of both hips and proximal femora, while the cross-table lateral provides a true lateral image of the proximal femur from a supine position. This setup is quick, widely available, and can detect most displaced femoral neck and intertrochanteric fractures, guiding immediate management. If the X-rays look normal but clinical suspicion remains high, MRI is the preferred next step because it can detect occult fractures that X-rays miss. CT can be used when MRI isn’t available or when a detailed fracture pattern is needed for planning. Ultrasound isn’t useful for diagnosing fractures.

When a hip fracture is suspected but the patient cannot bear weight, start with plain X-ray imaging of the pelvis and hip. An AP pelvis radiograph with a cross-table lateral view is the best initial combination because the AP view gives a broad picture of both hips and proximal femora, while the cross-table lateral provides a true lateral image of the proximal femur from a supine position. This setup is quick, widely available, and can detect most displaced femoral neck and intertrochanteric fractures, guiding immediate management.

If the X-rays look normal but clinical suspicion remains high, MRI is the preferred next step because it can detect occult fractures that X-rays miss. CT can be used when MRI isn’t available or when a detailed fracture pattern is needed for planning. Ultrasound isn’t useful for diagnosing fractures.