Hip fractures after a fall or minor trauma are a common problem, especially among older patients. Imaging tests are needed to accurately diagnose hip fractures and decide on the best treatment option. Recommended imaging tests for high-velocity trauma differ from falls and minor trauma and are not part of this appropriateness criteria summary; they are covered under different appropriateness criteria.
Radiography, or x-ray, of the hip and pelvis is the most appropriate first imaging test following fall or minor trauma and can be used to identify most hip fractures. When a hip fracture is not seen on x-ray but is suspected clinically, MRI of the pelvis and hips without intravenous (IV) contrast is the next best imaging test. Subtle findings of hip fractures that are not seen on x-ray and soft tissue injuries may be seen on MRI.
CT of the pelvis and hips without IV contrast is also generally appropriate as a second imaging test for suspected hip fracture not seen on x-ray. Though not as sensitive to subtle findings, CT is faster than MRI and is often used for people who have difficulties with the MRI procedure.