title: Another fractured neck of femur: do we need a lateral X-ray?
abstract: OBJECTIVE
  This study aimed to define the role of the lateral X-ray in the assessment and treatment planning of proximal femoral fractures. Occult fractures were not included.
  
  
  METHODS
  Radiographs from 359 consecutive patients with proximal femoral fractures admitted to our emergency department over a 12 month period were divided into anteroposterior (AP) views and lateral views. Three blinded reviewers independently assessed the radiographs, first AP views alone then AP plus lateral views, noting the fracture classification for each radiograph. These assessments were then compared with the intra-operative diagnosis, which was used as the gold standard. A 2 × 2 contingency square table was created and Pearson's χ(2) test was used for statistical analysis.
  
  
  RESULTS
  The rate of correct classification by the reviewers was improved by the assessment of the lateral X-ray in addition to the AP view for intracapsular fractures (p<0.013) but not for extracapsular fractures (p=0.27). However, the only advantage obtained by assessing the lateral view in intracapsular fractures was the detection of displacement where the fracture appeared undisplaced on the initial AP view.
  
  
  CONCLUSIONS
  This study provides statistical evidence that one view is adequate and safe for the majority of hip fractures. The lateral radiograph should not be performed routinely in order to make considerable savings in money and time and to avoid unnecessary patient discomfort.
authors.affiliation: Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK. b.almazedi@doctors.org.uk
authors.forename: B
authors.initials: B
authors.lastname: Almazedi
authors.forename: C D
authors.initials: CD
authors.lastname: Smith
authors.forename: D
authors.initials: D
authors.lastname: Morgan
authors.forename: G
authors.initials: G
authors.lastname: Thomas
authors.forename: G
authors.initials: G
authors.lastname: Pereira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology; D002985:Clinical Protocols; D005260:Female; D005265:Femoral Neck Fractures / Q000145:classification / Q000000981:diagnostic imaging*; D005592:Fracture Fixation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D014057:Tomography, X-Ray Computed / Q000379:methods*