The Hip

1

Radiographic examination

• Hip

  • AP pelvis

  • AP hip

  • Frog leg-view hip

  • Groin lateral hip

• Femur

  • AP hip

  • AP femoral shaft and condyles

  • Lateral femoral shaft and condyles

  • Oblique femoral shaft

2

Common sites of injury in adults

• Elderly – low-impact trauma (fall from standing height)

  • Femoral neck

  • Intertrochanteric

  • Greater trochanter

  • Pelvic fractures presenting as hip fractures

    • Pubic rami

    • Iliac wing

• Adult – R/O pathologic fracture

  • Basicervical fractures

  • Lesser trochanteric avulsions

  • Transverse subtrochanteric fractures

• Adult – high-impact trauma (MVC)

  • Posterior hip dislocation

  • Femoral neck

  • Subtrochanteric

  • Femoral shaft

3

Hip fractures rare in children and adolescents

• Pelvic fractures about hip common

  • Pubic rami

  • Iliac wing

• Occasional

  • Femoral neck

  • Posterior dislocation

  • Proximal femoral epiphyseal separation rare

    • Slipped capital femoral epiphysis (SCFE)

4

Injuries likely to be missed

• Low-impact trauma – elderly

  • Fine, subtle fractures

    • Femoral neck

    • Intertrochanteric

• High-impact trauma – all ages

  • Proximal injuries of the hip in association with femoral shaft fractures

    • Posterior dislocation of hip

    • Fracture of acetabulum

    • Fracture of femoral neck

5

Where else to look when you see something obvious