II. Precautions

  1. Hip XRay may miss non-displaced Femoral Fractures
    1. Consider MRI or CT for negative XRay with higher index of suspicion
    2. Parker (1992) Arch Emerg Med 9(1): 23-7 [PubMed]
    3. Hakkarinen (2012) J Emerg Med 43(20: 303-7 +PMID:22459594 [PubMed]

III. Imaging: Views

  1. Standard Views
    1. Anteroposterior Pelvis XRay (AP Pelvis XRay)
    2. Cross-Table Lateral Hip XRay
  2. Hip Avascular Necrosis
    1. Frog-leg Xray
  3. Hip Stress Fracture
    1. Maximal internal rotation hip

IV. Evaluation: Findings

  1. Pelvic Fracture
    1. XRay identifies 90% of bony pelvic injuries
    2. Evaluate "rings and lines"
      1. Three pelvic rings
      2. Lines (iliopectineal line, ilioischial line, Shenton line, arcuate line)
      3. Anterior and posterior wall
      4. Acetabulum roof
    3. Extra views (largely replaced by pelvic CT)
      1. Inlet View, Outlet View and Judet View may identify subtle Fractures
  2. Hip Stress Fracture
    1. Trace medial and lateral cortical margins of the femoral neck
      1. Follow S-shaped curve (where femoral head meets the femoral neck)
      2. Observe for sharp angle along the S-curve suggestive of Stress Fracture
    2. Trace medial (compressive) and lateral (tensile) trabecular lines through femoral shaft and into femoral head
      1. Observe closely for subtle disruptions in trabecular lines suggestive of Stress Fracture
  3. Hip Osteoarthritis
    1. Osteophytes (at acetabulum or femoral head)
    2. Subchondral cysts
    3. Bony sclerosis
  4. Hip Avascular Necrosis
    1. Crescent sign (inconsistently seen on Xray)
      1. Femoral head flattening of the superior aspect
      2. Subchondral Fracture parallel to articular surface
  5. Other findings
    1. Hip lesions (e.g. tumors)

V. References

  1. Shahideh (2013) Crit Dec Emerg Med 27(9):10-18

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Related Studies

Ontology: X-ray of pelvis and hip (C0860686)

Concepts Diagnostic Procedure (T060)
Italian Radiografia di bacino e anche, Radiografia del bacino e delle anche, Radiografia NAS di bacino e anche
Dutch röntgenfoto NAO bekken en heup, pelvis- en heupröntgenfoto, röntgenfoto van pelvis en heup
French Radiographie de bassin et de hanche SAI, Radio SAI du pelvis et de la hanche, Radiographie du bassin et de la hanche
German Roentgenaufnahme NNB Becken und Huefte, Becken und Huefte Roentgenaufnahme, Roentgen NNB des Beckens und der Huefte, Roentgen von Becken und Huefte
Portuguese Raios X NE da pélvis e da anca, Radiografia da pélvis e anca, Raios X NE da bacia e anca, Radiografia da bacia e da anca
Spanish Radiografía de pelvis y cadera NEOM, Radiografía de cadera y pelvis, Radiografía NEOM de pelvis y cadera, Radiografía de pelvis y cadera
Japanese 骨盤および股関節X線, 骨盤および股関節X線NOS, コツバンオヨビコカンセツXセンNOS, コツバンオヨビコカンセツXセン
Czech Rentgen pánve a kyčle NOS, Rentgen pánve a kyčle
English Pelvic & hip X-ray, X-ray NOS pelvis & hip, X-ray NOS pelvis and hip, X-ray of pelvis and hip
Hungarian Medence és csípő röntgen, Medence, csípő röntgen k.m.n., Medence és csípő röntgen k.m.n.