The Necessity of Hip Lateral Radiograph for Operative Decision in Two Common Hip Fractures

Recent studies showed that single hip anterio-posterior (AP) radiograph was adequate for diagnosis of most hip fractures (HF). However, lateral hip radiograph might be necessary to understand the fracture characteristics and to make better decision on surgical management.

100 HF radiographs (50 femoral neck fractures [FNF] and 50 intertrochanteric fractures [ITF]) were consecutively reviewed by five observers. The initial review used only single both hips AP radiograph. One month later, both hips AP and lateral films were reviewed. The diagnosis and operative decision were recorded, and then calculated.

The average rate of changing treatment by the assessment of lateral radiographs was 5.0% for all HF, 2.8% for FNF, and 7.2% for ITF. There was no significant difference among those rates between five observers (p<0.05 all). The Intraclass Correlation Coefficients (ICCs) for interobserver agreement regarding the operative decision using only single AP film were 0.787 (95% confidence interval [CI], 0.698 to 0.852) for all HF, 0.818 (95% CI, 0.699 to 0.893) for FNF, and 0.394 (95% CI, 0.130 to 0.606) for ITF. After using both AP and lateral film, the ICCs were changed into 0.792 (95% CI, 0.705 to 0.856) for all HF, 0.795 (95% CI, 0.663 to 0.879) for FNF, and 0.552 (95% CI, 0.323 to 0.720) for ITF.

Using single both hips AP radiograph for operative decision is adequate and safe for most hip fractures. However, some of intertrochanteric fractures may require lateral radiograph for better operative decision.