 Introduction/Background Fractures of the proximal femur (commonly referred to as hip fractures) are a frequent source of morbidity and mortality in elderly osteoporotic patients [1]. Typically the result of a ground-level fall, fractures of this type result in approximately 300,000 hospitalizations per year and are nearly twice as common in women as in men [2,3]. As the United States population continues to age, the incidence of hip fractures and associated medical costs will continue to rise, predicted to reach $18 billion by 2025 [4]. Patients suffer a substantial decline in quality of life following a hip fracture [5] as well as a 1-year mortality rate of 22% for women and 33% for men [1]. Delays in diagnosis and treatment are associated with increased cost, complication rate, length of hospital stay, and short- and long-term mortality [6-13]. Therefore, rapid diagnosis and treatment of hip fractures is critical. Hip fractures cannot be reliably diagnosed or excluded on the basis of physical examination alone; therefore, imaging plays a key role in early and accurate diagnosis [14]. Treatment for both intra- and extracapsular proximal femoral fractures in the elderly is typically surgical fixation because of the risk of further fracture displacement and the dangers of prolonged immobilization in the elderly [15]. Joint replacement may be performed for displaced fractures of the femoral neck where the risk of femoral head avascular necrosis is high. Fractures from high-force trauma are also commonly treated with surgical fixation for stability to reduce the risk of post-traumatic osteoarthritis. Reprint requests to: publications@acr.org Acute Hip Pain-Suspected Fracture Multiple studies have demonstrated that radiographs have limited sensitivity for fracture detection of the proximal femur, particularly in elderly osteoporotic patients [20-24].
Acute Hip Pain Suspected Fracture PCAs.  Introduction/Background Fractures of the proximal femur (commonly referred to as hip fractures) are a frequent source of morbidity and mortality in elderly osteoporotic patients [1]. Typically the result of a ground-level fall, fractures of this type result in approximately 300,000 hospitalizations per year and are nearly twice as common in women as in men [2,3]. As the United States population continues to age, the incidence of hip fractures and associated medical costs will continue to rise, predicted to reach $18 billion by 2025 [4]. Patients suffer a substantial decline in quality of life following a hip fracture [5] as well as a 1-year mortality rate of 22% for women and 33% for men [1]. Delays in diagnosis and treatment are associated with increased cost, complication rate, length of hospital stay, and short- and long-term mortality [6-13]. Therefore, rapid diagnosis and treatment of hip fractures is critical. Hip fractures cannot be reliably diagnosed or excluded on the basis of physical examination alone; therefore, imaging plays a key role in early and accurate diagnosis [14]. Treatment for both intra- and extracapsular proximal femoral fractures in the elderly is typically surgical fixation because of the risk of further fracture displacement and the dangers of prolonged immobilization in the elderly [15]. Joint replacement may be performed for displaced fractures of the femoral neck where the risk of femoral head avascular necrosis is high. Fractures from high-force trauma are also commonly treated with surgical fixation for stability to reduce the risk of post-traumatic osteoarthritis. Reprint requests to: publications@acr.org Acute Hip Pain-Suspected Fracture Multiple studies have demonstrated that radiographs have limited sensitivity for fracture detection of the proximal femur, particularly in elderly osteoporotic patients [20-24].