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Hip XRay

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Hip XRay, Pelvis XRay, XRay Hip, XRay Hip and Pelvis

  • See Also
  1. Hip Pain
  2. Hip Exam
  3. Hip Stress Fracture
  • 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]
  • 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
  • Evaluation
  • Findings
  1. Pelvic Fracture
    1. XRay identifies 90% of bony pelvic injuries
    2. Pelvis is a three ringed pretzel (large central inlet, two smaller obturator canals)
      1. Ringed structures typically break in at least two places
      2. When one Pelvic Fracture line is found, identify the other(s)
    3. Evaluate "rings and lines" (comparing to opposite side)
      1. Three pelvic rings
      2. Lines (iliopectineal line, ilioischial line, Shenton line, arcuate line)
      3. Anterior and posterior wall
      4. Acetabulum roof
      5. Pelvic joint widening (SI Joint, Pubic Symphysis)
    4. Additional 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)
  • References
  1. Shahideh (2013) Crit Dec Emerg Med 27(9):10-18