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Review Question - QID 3170

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QID 3170 (Type "3170" in App Search)
A 15-year-old male falls from his bicycle and lands directly on his left hip. He is unable to bear weight and presents to the emergency department with the AP pelvis radiograph seen in Figure A. Which of the following radiographic views could aid in classifying this patient's fracture pattern?
  • A

Iliac oblique (Judet) view

3%

70/2065

Traction AP of the hip with the leg in neutral rotation

7%

150/2065

Outlet view of the pelvis

1%

23/2065

Traction AP of the hip with the leg internally rotated 15°

79%

1623/2065

Traction AP of the hip with the leg externally rotated 15°

9%

189/2065

  • A

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The ability to define the location of a femoral neck fracture aids in determining the optimal treatment. The addition of a "traction-internal rotation" view (as described in Answer 4) to standard hip radiographs may assist with classification of femoral neck fractures by accounting for the anteversion of the femoral neck.

Koval et al performed a study in which proximal femur fractures were classified with standard radiographs (AP pelvis, AP hip, cross-table lateral), followed by the addition of a physician-assisted view with traction and 15 degrees of internal rotation. The inclusion of the traction-internal rotation view led to increased agreement in classification between the authors, and was especially helpful for differentiating displaced femoral neck fractures versus stable intertrochanteric fractures.

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