US Hip The use of US for evaluation of the acutely painful hip has been evaluated in a single study of 10 patients with hip fractures [36]. Although US was able to identify trauma-related changes, such as joint effusion, with 100% sensitivity, specificity for fracture reached only 65%. The authors acknowledged that performance might further decrease for examinations performed by sonographers and radiologists not experienced with musculoskeletal US. For this document, it is assumed the procedure is performed and interpreted by an expert. Given the inability of US to comprehensively evaluate the bones and soft tissues of the pelvis, there is not enough evidence to support the role of US in the workup of radiographically occult hip fracture. Acute Hip Pain-Suspected Fracture Bone Scan Hips Prior to the advent of MRI, a bone scan was the preferred test for radiographically occult proximal femoral fractures. However, as early as 1993, Rizzo et al [50] demonstrated MRI to be at least as accurate as bone scans and with substantially decreased time to diagnosis. A later study by Rubin et al [51] comparing bone scans and MRI demonstrated improved sensitivity and specificity of MRI relative to bone scans. Moreover, the bone scan group averaged an additional day to surgery. Bone scintigraphy is a time-consuming process. Bone scans may be falsely negative for up to 72 hours from the time of injury, and false-positive scans are likewise common, related to osteoarthritis, soft-tissue injury, or any other process that may increase bone turnover [50]. It has been postulated that performing single-photon emission computed tomography may combine the sensitivity of bone scintigraphy with the spatial accuracy of CT, but there are no data to support this view. In current practice, the role of bone scans as a secondary line of imaging in patients with contraindications to MRI has largely been usurped by CT.
Acute Hip Pain Suspected Fracture PCAs. US Hip The use of US for evaluation of the acutely painful hip has been evaluated in a single study of 10 patients with hip fractures [36]. Although US was able to identify trauma-related changes, such as joint effusion, with 100% sensitivity, specificity for fracture reached only 65%. The authors acknowledged that performance might further decrease for examinations performed by sonographers and radiologists not experienced with musculoskeletal US. For this document, it is assumed the procedure is performed and interpreted by an expert. Given the inability of US to comprehensively evaluate the bones and soft tissues of the pelvis, there is not enough evidence to support the role of US in the workup of radiographically occult hip fracture. Acute Hip Pain-Suspected Fracture Bone Scan Hips Prior to the advent of MRI, a bone scan was the preferred test for radiographically occult proximal femoral fractures. However, as early as 1993, Rizzo et al [50] demonstrated MRI to be at least as accurate as bone scans and with substantially decreased time to diagnosis. A later study by Rubin et al [51] comparing bone scans and MRI demonstrated improved sensitivity and specificity of MRI relative to bone scans. Moreover, the bone scan group averaged an additional day to surgery. Bone scintigraphy is a time-consuming process. Bone scans may be falsely negative for up to 72 hours from the time of injury, and false-positive scans are likewise common, related to osteoarthritis, soft-tissue injury, or any other process that may increase bone turnover [50]. It has been postulated that performing single-photon emission computed tomography may combine the sensitivity of bone scintigraphy with the spatial accuracy of CT, but there are no data to support this view. In current practice, the role of bone scans as a secondary line of imaging in patients with contraindications to MRI has largely been usurped by CT.