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It is almost exclusively used in the pediatric population to assess for slipped upper femoral epiphysis (SUFE) and Perthes disease. bilateral examination allows for better visualization of the hip joints and femoral neck.lataral projection to aid and diagnose femoroacetabular impingement (FAI) due to its increased sensitivity for detecting femoral head-neck asphericity.the ideal projection for bilateral hip or femur trauma.lateral projection demonstrating the neck of the femur without movement of the either limb.can only be conducted on unilateral hip trauma.lateral projection demonstrating the neck of the femur without movement of the affected limb.standard rolled lateral view demonstrating the femoral neck and acetabular rim can only be performed on non-trauma patients.often only performed in follow up studies.demonstrates the hip joint in the AP plane, with the limb internally rotated so the neck of the femur is in profile.Hip radiographs are performed for a variety of indications including 1-3: The series is requested for a myriad of reasons from trauma to atraumatic hip pain. In the two cases presented, plain X-rays failed to document hip fractures (case 1) and AVN (case 2), respectively, both of which were later diagnosed on MRI studies.The hip series is comprised of an anteroposterior (AP) and lateral radiograph of the hip joint. However, despite negative X-ray of both hips, the hip MRI revealed avascular necrosis (AVN) of both femoral heads requiring subsequent orthopedic management.Ĭonclusion: Hip pathology may mimic lumbar spinal stenosis. The neurological examination was normal, except for positive straight leg raising bilaterally at 60°. Case 2 – A 35-year-old male presented with low backache and right hip pain of 1 month’s duration. He underwent screw fixation of the hip fractures and later underwent endoscopic decompression of the spinal stenosis. Although X-rays of both hips were negative, the MRI showed bilateral femoral neck fractures. The lumbar MRI showed L5-S1 spinal stenosis. Straight leg raising test was positive at 70° (right) and 60° (left), and he had left lower extremity numbness and weakness. Although the history and clinical examination may help differentiate between the two, hip X-rays alone without accompanying magnetic resonance imaging (MRI) studies may prove unreliable.Ĭase Descriptions: Case 1 – A 72-year-old male presented with the sudden onset of severe back and left posterior thigh pain. Medical School, Medical School University of Debrecen, Debrecen, Hungary.ĭepartments of Neurosurgery Nanoori Hospital, Seoul, Republic of Korea,ĭOI:10.25259/SNI_173_2019Copyright: © 2019 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.īackground: Occasionally, hip pathologies may present alone or combined with lumbar spine pathology, especially lumbar stenosis.It may be performed as a second test after a hip or knee x-ray has demonstrated a femoral fracture. It is performed to look for evidence of injury (or pathology) affecting the femur. Departments of Orthopaedics, Nanoori Hospital, Seoul, Republic of Korea, A femur x-ray, also known as femur series or femur radiograph, is a set of two x-rays performed of the entire femur.Department of Neurosurgery, University of Michigen, Michigen, United States,.Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, New Delhi, India,.Departments of Neurosurgery Nanoori Hospital, Seoul, Republic of Korea,.Department of Orthopaedics and Spine, Private Practice, Jaypee Hospital, Noida, Uttar Pradesh,.Article Type: Ravindra Singh, Hyeun-Sung Kim, Nitin Adsul, Osama Nezar Kashlan, Sung Woon Oh, Jung Hoon Noh, Soeng Cheol Moon, Chang Hwan Park, Il Tae Jang, Seong Hoon Oh