Although they remain the mainstay for initial imaging, pelvis and hip radiographs share the same limitations in sensitivity and specificity for fracture detection, and negative radiographs alone cannot exclude fracture. MRI Pelvis and Affected Hip At least 90% of proximal femoral fractures will be identified on radiographs [21]. Therefore, MRI without intravenous (IV) contrast is reserved for second-line imaging in instances of negative radiographs with continued clinical suspicion for fracture rather than as a first-line modality. Acute Hip Pain-Suspected Fracture The use of contrast-enhanced MRI has been explored as a technique to assess femoral head perfusion in cases of proximal femoral fracture [32,33], but this modality does not play a role in initial imaging assessment. CT Pelvis and Hips Although not as sensitive as MRI, noncontrast CT is also reserved as a problem-solving modality following radiography either to evaluate for radiographically occult fracture or to better depict fracture morphology for treatment planning purposes [34,35]. There is no relevant literature to support the use of contrast-enhanced CT as an initial imaging modality in instances of acute hip pain following low-force trauma. There is no relevant literature to support the use of multiphase CT as an initial imaging modality in instances of acute hip pain following low-force trauma. US Hip Although there has been limited investigation into the use of ultrasound (US) for hip fracture detection, US does not play a role as the initial imaging in this setting [36]. Bone Scan Hips There is no relevant literature to support the use of a nuclear medicine bone scan as an initial imaging modality in instances of acute hip pain following low-force trauma. Variant 2: Acute hip pain. Fall or minor trauma. Negative radiographs. Suspect fracture. Next imaging study.
Acute Hip Pain Suspected Fracture PCAs. Although they remain the mainstay for initial imaging, pelvis and hip radiographs share the same limitations in sensitivity and specificity for fracture detection, and negative radiographs alone cannot exclude fracture. MRI Pelvis and Affected Hip At least 90% of proximal femoral fractures will be identified on radiographs [21]. Therefore, MRI without intravenous (IV) contrast is reserved for second-line imaging in instances of negative radiographs with continued clinical suspicion for fracture rather than as a first-line modality. Acute Hip Pain-Suspected Fracture The use of contrast-enhanced MRI has been explored as a technique to assess femoral head perfusion in cases of proximal femoral fracture [32,33], but this modality does not play a role in initial imaging assessment. CT Pelvis and Hips Although not as sensitive as MRI, noncontrast CT is also reserved as a problem-solving modality following radiography either to evaluate for radiographically occult fracture or to better depict fracture morphology for treatment planning purposes [34,35]. There is no relevant literature to support the use of contrast-enhanced CT as an initial imaging modality in instances of acute hip pain following low-force trauma. There is no relevant literature to support the use of multiphase CT as an initial imaging modality in instances of acute hip pain following low-force trauma. US Hip Although there has been limited investigation into the use of ultrasound (US) for hip fracture detection, US does not play a role as the initial imaging in this setting [36]. Bone Scan Hips There is no relevant literature to support the use of a nuclear medicine bone scan as an initial imaging modality in instances of acute hip pain following low-force trauma. Variant 2: Acute hip pain. Fall or minor trauma. Negative radiographs. Suspect fracture. Next imaging study.