Previous literature regarding the accuracy of radiography has almost exclusively evaluated AP and cross-table lateral radiographs of the hip or the combined use of AP pelvis and hip radiographs. However, it is well established that patients with clinically suspected proximal femur fracture often have fractures of the pelvis, including the sacrum and pubic rami [21,27-30]. Therefore, it has been recommended that the radiographic series include the AP view of the pelvis along with the orthogonal views of the symptomatic hip [31]. The inclusion of a pelvis radiograph also allows for comparison of potential abnormalities to the contralateral asymptomatic side. Pelvis radiographs share the same limitations in sensitivity and specificity for fracture detection as hip radiographs, and a negative radiograph alone cannot exclude fracture. Radiography Pelvis and Hip As previously discussed, patients with clinically suspected proximal femur fracture often have fractures of the pelvis that include the sacrum and pubic rami [21,27-30]. Moreover, these pelvic fractures may occur in isolation or concomitant with a fracture of the proximal femur [28]. Therefore, it has been recommended that the radiographic series include both the AP view of the pelvis along with orthogonal views of the symptomatic hip [31]. The inclusion of a pelvis radiograph also allows for comparison of potential abnormalities to the contralateral asymptomatic side. For these reasons, an AP view of the pelvis with a cross-table lateral view of the symptomatic hip is the standard approach at many institutions, whereas some will include three views: an AP view of the pelvis, a separate AP view of the symptomatic hip, and the cross-table lateral view. There is no specific literature to compare these two approaches.
Acute Hip Pain Suspected Fracture PCAs. Previous literature regarding the accuracy of radiography has almost exclusively evaluated AP and cross-table lateral radiographs of the hip or the combined use of AP pelvis and hip radiographs. However, it is well established that patients with clinically suspected proximal femur fracture often have fractures of the pelvis, including the sacrum and pubic rami [21,27-30]. Therefore, it has been recommended that the radiographic series include the AP view of the pelvis along with the orthogonal views of the symptomatic hip [31]. The inclusion of a pelvis radiograph also allows for comparison of potential abnormalities to the contralateral asymptomatic side. Pelvis radiographs share the same limitations in sensitivity and specificity for fracture detection as hip radiographs, and a negative radiograph alone cannot exclude fracture. Radiography Pelvis and Hip As previously discussed, patients with clinically suspected proximal femur fracture often have fractures of the pelvis that include the sacrum and pubic rami [21,27-30]. Moreover, these pelvic fractures may occur in isolation or concomitant with a fracture of the proximal femur [28]. Therefore, it has been recommended that the radiographic series include both the AP view of the pelvis along with orthogonal views of the symptomatic hip [31]. The inclusion of a pelvis radiograph also allows for comparison of potential abnormalities to the contralateral asymptomatic side. For these reasons, an AP view of the pelvis with a cross-table lateral view of the symptomatic hip is the standard approach at many institutions, whereas some will include three views: an AP view of the pelvis, a separate AP view of the symptomatic hip, and the cross-table lateral view. There is no specific literature to compare these two approaches.