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Johns Hopkins Medical Imaging

Acute Hip Pain

  • Radiography is the best first modality for the evaluation of a patient with acute hip pain. The literature recommends against the frog-leg lateral view in  ases of suspected proximal femoral fracture or dislocation, as it may further displace the fracture and complicate the injury.
  • MRI is the most appropriate imaging choice for evaluating radiographically occult fracture in individuals individuals >80 years old.
  • CT and bone scintigraphy are second-line modalities.
  • Patients >50 years old with fractures from minimal to no trauma should undergo a DXA study for osteoporosis evaluation.

Suspected Fracture

Positive radiographs:

Management based on findings

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Radiographs

  • AP pelvis
  • X-table lateral bilateral hips

hip xray graphic

Negative or indeterminate radiographs:

MRI pelvis and affected hip without contrast:

  • • MRI is more sensitive, specific, accurate and cost-effective.
CT pelvis and hips without contrast (lower rating as per ACR appropriateness criteria):
  • Fracture in the setting of high-energy trauma because the high force would likely cause cortical disruption.

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This work is intended for use to assist hospital and healthcare audiences; however, Johns Hopkins makes no representations or warranties concerning the content or clinical efficacy of this work, its accuracy or completeness. Johns Hopkins is not responsible for any errors or omissions or for any bias, liability or damage resulting from the use of this work. This work is not intended to be a substitute for professional judgment, advice or individual root cause analysis.