EMRad: Radiologic Approach to the Traumatic Hip/Pelvis

This is EMRad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department [1]. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. Next up: the hip. Learning Objectives Interpret traumatic hip x-rays using a standard approach Identify clinical scenarios in which an additional view might improve pathology diagnosis Why the hip matters and the radiology rule of 2’s The Hip Hip and thigh pain are common complaints in the ED [2]. Hip fractures have a very high one-year mortality [2]. Compared with CT, pelvic radiographs have a sensitivity of 64% to 78% for the identification of pelvic fractures in blunt trauma [3]. 2% of occult hip fractures will be missed by CT. Consider MRI for patients with significant hip pain and negative x-rays [2]. MRI hip protocols can be done in as little as 5-15 minutes. Before we begin: Make sure to employ the rule of 2’s [4] 2 views: One view is never enough 2 abnormalities: If you see one abnormality, look for another 2 joints: Image above and below the injury 2 sides: If unsure regarding a potential pathologic finding, compare to another side 2 occasions: Always compare with old x-rays if available 2 visits: Bring patient back for repeat films An approach to the traumatic adult hip x-ray Adequacy Bones Inner Pelvic Ring Obturator Foramina Sacral Foramina Outer Pelvic Ring Acetabulum Iliopectineal Line Ilioischial Line Femur Shelton’s Line Cartilage/Joints The SI Joint Pubic Symphysis Consider an additional view      1. Adequacy A standard “hip series” consists of the AP view of the pelvis and a lateral view of … Continue reading EMRad: Radiologic Approach to the Traumatic Hip/Pelvis