Lateral X-ray for proximal femoral fractures - Is it really necessary?
BACKGROUND
Historically routine work up of a patient with a proximal femoral fracture always included anterior-posterior (AP) and a lateral film of the hip. The aim was to define the role of the lateral X-ray in the assessment and surgical planning of proximal femur fractures.


METHODS
Radiographs of 320 consecutive patients with proximal femoral fractures who were admitted over a 12 months period were divided into lateral and AP views. Two blinded reviewers independently assessed the AP view alone and then the AP plus the lateral view. Fracture classification was noted for each X-ray and then compared with intraoperative diagnosis which was our study's gold standard. A 2 × 2 contingency square table and Pearson's x(2) test were used for statistical analysis.


RESULTS
The rate of correct classification by the reviewers enhanced by the assessment of the lateral X-ray in addition to the AP view for intracapsular fractures (p = 0.018) but not for extracapsular fractures (p = 0.29). Operative management did not change for intracapsular fractures which appeared displaced on initial AP view after reviewing the lateral X-ray. The only advantage of obtaining a lateral view in intracapsular fracture was the detection of displacement were the fracture appeared to be undisplaced on initial AP view.


CONCLUSIONS
This study provides statistical evidence that one view is adequate and safe for majority of proximal femoral fractures. The lateral radiograph should not be performed on a routine basis thus making considerable saving in time and money, and avoiding unnecessary radiation exposure and discomfort to the patient.
Department of Orthopaedics, Calderdale and Huddersfield Foundation Trust, West Yorkshire HD3 3EA, United Kingdom. Electronic address: osmanriaz@doctors.org.uk.
Osman
O
Riaz
Department of Orthopaedics, Calderdale and Huddersfield Foundation Trust, West Yorkshire HD3 3EA, United Kingdom.
Sohail
S
Nisar
Department of Orthopaedics, Calderdale and Huddersfield Foundation Trust, West Yorkshire HD3 3EA, United Kingdom.
Rizwan
R
Arshad
Department of Orthopaedics, Calderdale and Huddersfield Foundation Trust, West Yorkshire HD3 3EA, United Kingdom.
Raees
R
Vanker
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005265:Femoral Neck Fractures / Q000145:classification / Q000000981:diagnostic imaging* / Q000601:surgery; D006615:Hip / Q000000981:diagnostic imaging; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011859:Radiography / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted
Hip fractures; Lateral X-ray; Lateral radiograph; Proximal femur fracture