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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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