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Fracture, Hip: Differential Diagnoses & Workup

Author: Moira Davenport, MD, Attending Physician, Departments of Emergency Medicine and Orthopedic Surgery, Allegheny General Hospital
Contributor Information and Disclosures

Updated: Apr 23, 2009

Differential Diagnoses

Dislocations, Hip
Fractures, Pelvic

Workup

Laboratory Studies

  • Laboratory studies are not useful in the diagnosis of fracture. Preoperative laboratory studies usually are drawn.

Imaging Studies

  • Anteroposterior (AP) and lateral views demonstrate most fractures.
    • If a fracture is not obvious, look for alteration of the Shenton line and compare it to the other hip. In addition, check the neck-shaft angle, which is determined by measuring the angle created by lines drawn through the centers of the femoral shaft and femoral neck. This should be approximately 120-130°.
    • For patients in whom femoral neck fracture is strongly suspected but standard x-ray findings are negative, an AP view with internal rotation provides a better view of the femoral neck.
  • If radiographic findings are equivocal but the history and physical examination are concerning for fracture, CT scan should be considered, particularly in unstable patients or those for whom MRI would be significantly delayed.
  • MRI and bone scan
    • If standard radiograph findings are negative and hip fracture still is strongly suspected, MRI and bone scan have high sensitivity in identifying occult injuries.
    • MRI is 100% sensitive in patients with equivocal radiographic findings.
    • Traditionally, bone scan has been thought to be unreliable before 48-72 hours after fracture, but one study found a sensitivity of 93% regardless of time from injury, including fractures less than 24 hours old.
    • For patients in whom a fracture is strongly suspected and radiographs are negative, consider admission if MRI or bone scan is not readily available.

More on Fracture, Hip

Overview: Fracture, Hip
Differential Diagnoses & Workup: Fracture, Hip
Treatment & Medication: Fracture, Hip
Follow-up: Fracture, Hip
Multimedia: Fracture, Hip
References
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References

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Further Reading

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Keywords

hip fracture, fracture of the hip, femoral head fractures, femoral neck fractures, intertrochanteric fractures, trochanteric fractures, subtrochanteric fractures, hip joint, iliofemoral ligament, pubofemoral ligament, ischiofemoral ligament, avascular necrosis, intracapsular fracture, extracapsular fracture, anterior dislocation, posterior dislocation, single fragment fracture, comminuted fracture, stress fracture, incomplete fracture, impacted fracture, partially displaced fracture, completely displaced fracture, single fracture lines, multiple fracture lines, nondisplaced fracture

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Contributor Information and Disclosures

Author

Moira Davenport, MD, Attending Physician, Departments of Emergency Medicine and Orthopedic Surgery, Allegheny General Hospital
Moira Davenport, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Francis Counselman, MD, Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School
Francis Counselman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital, Manhattan
Eric Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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