Hip & proximal femur
Normal anatomy
AP view
AP and lateral views
The femoral neck should:
The intertrochanteric region should:
Secondary centres (apophyses)
The femur and pelvis of an adolescent will show several small secondary centres (the apophyses).
Analysis: the checklists
Detailed inspection should focus on the specific clinical history. Thus…
An elderly patient has suffered a simple fall
Check for:
▪ A black line—a displaced fracture—across the femoral neck.
A few fractures are very difficult to detect. If the radiographs appear superficially normal it is important to check again and answer the following questions:
An adolescent patient has acute/chronic pain following athletic activity
Check that:
Patient of any age who has sustained high velocity trauma
Check all of the features described above and also check:
Hip pain in a young patient with no history of recent trauma
▪ Age 4–10 years: consider Perthe’s disease of the femoral head.
▪ Around the age of puberty: consider slipped capital femoral epiphysis.
Normal lateral view. The same patient as above. The two sites that must be checked are the neck of the femur and the trochanteric region. This peculiar projection might seem anatomically counterintuitive—see explanation on p. 228.
