X-ray of hip fractures

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Author: Mikael Häggström [notes 1]

Hip fractures are fractures of the proximal femur.


X-ray shows a suspected mildly compressed hip fracture, as incongruity of the cortex.

Even if there's an initial obvious fracture, evaluate:

  • Bone contours for disruptions
  • Bone areas for unusual lines that are either hypoattenuating (in case of separation) or hyperattenuating (in case of compression)

Also have a glance at the projected pelvic bones.

Further imaging

If findings are equivocal of a fracture, or there is a strong clinical suspicion despite a normal X-ray, further imaging can be done with CT and/or MRI:

Case 1

Continued from X-ray above:

Further information: X-ray of the hip#Prostheses and other orthopedic fixations
Case 2


Hip fracture classification.png


In AO classification, these fractures are classified as either nondisplaced or displaced (not necessarily including how much).[1]


Trochanteric fractures are subdivided into either intertrochanteric (between the greater and lesser trochanter[2]) or pertrochanteric (through the trochanters[2][3]) by the Müller AO Classification of fractures.[4] Practically, the difference between these types is minor. The terms are often used synonymously.[5][6] An isolated trochanteric fracture involves one of the trochanters without going through the anatomical axis of the femur, and may occur in young individuals due to forceful muscle contraction.[7] Yet, an isolated trochanteric fracture may not be regarded as a true hip fracture because it is not cross-sectional.


Types of fracture misalignment:[8]
  • Displacement
  • Angulation
  • Distraction (making bone longer)
  • Impaction or shortening
  • Rotation


General notes on fracture reporting


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.


  1. . Revised AO/OTA classification (Jan 2018) - Proximal femur. Retrieved on 2018-06-19.
  2. 2.0 2.1 Page 245 in: David J. Dandy, Dennis J. Edwards (2009). Essential Orthopaedics and Trauma, 5th edition . Elsevier Health Sciences. ISBN 9780702042096. 
  3. Schipper, Inger B.; Steyerberg, Ewout W.; Castelein, Rene M.; Vugt, Arie B. van (2009). "Reliability of the AO/ASIF classification for pertrochanteric femoral fractures ". Acta Orthopaedica Scandinavica 72 (1): 36–41. doi:10.1080/000164701753606662. 
  4. Ernst Raaymakers, Inger Schipper, Rogier Simmermacher, Chris van der Werken. Proximal femur. AO Foundation. Archived from the original on 24 April 2017. Retrieved on 2017-04-23.
  5. Page 190 in: Richard A. Gosselin, David A. Spiegel, Michelle Foltz (2014). Global Orthopedics: Caring for Musculoskeletal Conditions and Injuries in Austere Settings . Springer Science & Business. ISBN 9781461415787. 
  6. Page 365 in: Anita K. Simonds (2007). Non-Invasive Respiratory Support, Third edition: A Practical Handbook . CRC Press. ISBN 9780340809846. 
  7. Page 303 in: Thomas Pope, Hans L. Bloem, Javier Beltran, William B. Morrison, David John Wilson (2014). Musculoskeletal Imaging E-Book (2 ed.). Elsevier Health Sciences. ISBN 9780323278188. 
  8. . Introduction to Trauma X-ray. Radiology Masterclass. Retrieved on 2018-07-03.

External links