Periosteal reaction: nonspecific radiographic finding that indicates periosteal irritation (e.g.

Effusion: hyperdensity, fluid-level (e.g.

Inspect the soft tissue surrounding the bones and joints for: Sacroiliitis visible on a pelvic X-ray 7 Soft tissue & other

Sclerosis of the endplates particularly on the iliac sideįigure 9.

X-ray has low diagnostic sensitivity, but potential radiographic features include: The condition is typically associated with ankylosing spondylitis. Sacroiliitis involves inflammation of one or both sacroiliac joints and typically presents with buttock and/or lower back pain.

Subtrochanteric (fracture is distal to the trochanters).

Intertrochanteric (fracture runs between the lesser/greater trochanters).

long-term steroid use can result in spontaneous avascular necrosis).Įxtracapsular fractures do not involve the neck of the femur and are located below the intertrochanteric line: Remember that AVN is not just limited to NOF fractures, highlighting the importance of clinical context (e.g. This means there is a higher chance of avascular necrosis (AVN) as well as fracture non-union/poor healing. This fracture type disrupts the joint capsule and therefore potentially the blood supply to the femoral head (branches of the profunda femoris, most importantly the lateral circumflex arteries).

Basicervical (distal femoral neck at the NOF base).Sub-capital (just distal to femoral head – Figure 5).Intracapsular fractures are located at the neck of the femur (NOF): It is important to understand the difference between intracapsular and extracapsular fractures (Figure 4), as the management and prognosis differ significantly. It is important to note that loss of contour of Shenton’s line does not always mean there is an underlying fracture (and so an intact Shenton’s line does not always rule out a NOF fracture), and thus should be used with caution when interpreting pelvic X-rays. Interruption of Shenton’s line may suggest a neck of femur (NOF) fracture in adults or DDH in children.Shenton’s line runs anatomically along the medial edge of the femoral neck and the inferior edge of the superior pubic ramus (Figure 3).Inspect all visible elements of the femur including: Symmetry: absence of symmetry can allow identification of subtle abnormalities.Bony texture: including trabecular lines of the femur that may indicate joint disruption.Cortical outline: identifying any bony fragments or fractures.Bones General approachĪssess the following characteristics of both the femur and visible pelvis: Not all hip fractures are visible on initial X-ray and follow-up cross-sectional imaging may be required if there is ongoing clinical concern. AlignmentĮnsure that the coccyx tip and pubic symphysis are in the midline. It is important to apply a systematic approach to the interpretation of any X-ray a commonly used approach with musculoskeletal imaging is ABCS:Įnsure the appropriate anatomy is visible within the borders of the image: usually above iliac crests to one-third down the femoral shaft. This view is often used in paediatric patients for pathologies such as slipped upper femoral epiphysis (SUFE) and developmental dysplasia of the hip (DDH). The lateral view has the patient lying supine in a frog-leg position the patient’s knees are flexed, with their hip abducted and externally rotated. The patient is either standing or supine, and usually, have both legs internally rotated so as not to obscure the femoral neck length. The AP view obtains a view of the whole pelvis, usually from the femoral shaft to above the ilium. There are two standard projections produced when a hip X-ray is performed: You might also be interested in our premium collection of 1,000+ ready-made OSCE Stations, including a range of radiology interpretation stations ✨ Views If previous radiographs are available, these should also be reviewed to provide a point of reference. Patient details (name, date of birth, unique identification number).Confirm detailsīegin by confirming you have the correct patient and the correct radiograph by assessing the following: Consider abnormalities in the broader clinical context of the specific patientįor the purpose of this article, we will concentrate on a systematic approach to interpreting hip X-rays with an antero-posterior (AP) view, which is the commonest and most likely to be presented to you in an exam situation.

Apply a systematic approach to interpretation.Some salient points to remember when interpreting any radiological scan include: It should be noted that projectional radiography has limitations and other imaging modalities such as MRI and CT should be considered if further evaluation is required. Hip X-rays are a frequently requested radiological investigation and the ability to interpret them is a key clinical skill.

Normal hip xray review