Re-evaluating the lateral hip view in the management of femoral neck fractures

Classification and management of femoral neck fractures remains debatable. In many institutions, lateral hip X-rays are routinely obtained on all suspected fractures. Studies exist questioning the impact of the routine lateral view on fracture management. This study re-evaluates lateral hip X-rays, looking at their adequacy and subsequent effect on management planning. Twelve orthopaedic surgeons were retrospectively asked to decide the management of 30 femoral neck fractures solely from their antero-posterior view. The same films were then re-shown in conjunction with their lateral view. Observers were asked to comment on lateral X-ray adequacy and again note their choice of management. Results were compared with respect to management plan and film adequacy. In 21.1% of cases, addition of the lateral X-ray resulted in a change in management plan. Twenty-six of the 30 fractures had their management changed by at least 1 observer when the lateral view was added. The lateral X-ray was deemed adequate in 79.4% of cases. Change in management was not related to whether fractures were intra- or extracapsular (P = 0.781). The lateral hip view does alter the management in a significant proportion of femoral neck fractures. The potential costs (both patient and institutional) of not obtaining a lateral view on this group are great, and thus, in contrast to previous studies, we advocate the lateral view continues to be obtained routinely.