What test should be ordered to confirm suspicions of a hip fracture in an elderly patient presenting with external rotation and a shortened hip?

What test should be ordered to confirm suspicions of a hip fracture in an elderly patient presenting with external rotation and a shortened hip?

• A. Gallium scan
• B. AP and lateral hip radiographs
• C. Skeletal survey
• D. Kite view radiographs

Answer: (B)

In cases of suspected hip fracture, especially in elderly patients who often present with characteristic findings such as external rotation and a shortened limb on the affected side, the most appropriate and standard diagnostic test is AP and lateral hip radiographs. These views provide a clear assessment of the hip joint and surrounding structures, allowing for the visualization of fractures, dislocations, or other bony abnormalities. The anteroposterior (AP) view gives a broad overview of the hip joint, while the lateral view can detail the neck and head of the femur, which are common sites for fractures. This combination is crucial for both detecting fractures and determining their type, which will influence management and treatment decisions. Other imaging modalities mentioned may have their roles in specific contexts but are not first-line tests for a suspected hip fracture. For example, a gallium scan is generally used for detecting bone infection or metabolic activity rather than acute fractures. A skeletal survey is more suited for assessing skeletal injuries in cases of suspected child abuse or metabolic bone disease. Kite view radiographs are specialized and typically used for evaluating certain hip conditions in children, not for the typical evaluation of fractures in adults.

In cases of suspected hip fracture, especially in elderly patients who often present with characteristic findings such as external rotation and a shortened limb on the affected side, the most appropriate and standard diagnostic test is AP and lateral hip radiographs. These views provide a clear assessment of the hip joint and surrounding structures, allowing for the visualization of fractures, dislocations, or other bony abnormalities.

The anteroposterior (AP) view gives a broad overview of the hip joint, while the lateral view can detail the neck and head of the femur, which are common sites for fractures. This combination is crucial for both detecting fractures and determining their type, which will influence management and treatment decisions.

Other imaging modalities mentioned may have their roles in specific contexts but are not first-line tests for a suspected hip fracture. For example, a gallium scan is generally used for detecting bone infection or metabolic activity rather than acute fractures. A skeletal survey is more suited for assessing skeletal injuries in cases of suspected child abuse or metabolic bone disease. Kite view radiographs are specialized and typically used for evaluating certain hip conditions in children, not for the typical evaluation of fractures in adults.