title: An algorithm to standardise the investigation of the undiagnosed traumatic painful adult hip: results at one year.
abstract: BACKGROUND
  A significant number of adults present to accident and emergency departments with a painful hip following a fall. When plain radiography is non-diagnostic, it has been traditionally difficult to decide on further investigations as rapid access MRI is still unavailable in many NHS hospitals and, therefore, alternative methods of reliable investigation are required.
  
  
  METHODS
  An algorithm was designed for the management of these patients without the availability of MRI investigation. Over a 60-week period, 278 patients were admitted of whom 31 were adult patients with trauma-related hip pain with no fracture on plain radiography.
  
  
  RESULTS
  We revealed 42% had fractures of the hip or pelvic girdle. None of the hip fractures deteriorated to a worse prognostic grade during the investigation process and no hip fractures were missed.
  
  
  CONCLUSIONS
  This approach towards a challenging diagnostic problem has been successful in identifying all hip fractures, and no fracture has deteriorated to a worse prognostic group.
authors.affiliation: Department of Orthopaedics, Royal Shrewsbury Hospital, Shrewsbury, Shropshire, UK. JPWhittaker@onetel.com
authors.forename: J P
authors.initials: JP
authors.lastname: Whittaker
authors.forename: W
authors.initials: W
authors.lastname: Goude
authors.forename: S E
authors.initials: SE
authors.lastname: Robbins
authors.forename: S M
authors.initials: SM
authors.lastname: Hay
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D004739:England; D005260:Female; D006620:Hip Fractures / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011877:Radionuclide Imaging; D014057:Tomography, X-Ray Computed