Ward, Robert J., Weissman, Barbara N., Kransdorf, Mark J., Adler, Ronald, Appel, Marc, Bancroft, Laura W., Bernard, Stephanie A., Bruno, Michael A., Fries, Ian Blair, Morrison, William B., Mosher, Timothy J., Roberts, Catherine C., Scharf, Stephen C., Tuite, Michael J., Zoga, Adam C.
abstract
Substantial cost, morbidity, and mortality are associated with acute proximal femoral fracture and may be reduced through an optimized diagnostic imaging workup. Radiography represents the primary diagnostic test of choice for the evaluation of acute hip pain. In middle aged and elderly patients with negative radiographs, the evidence indicates MRI to be the next diagnostic imaging study to exclude a proximal femoral fracture. CT, because of its relative decreased sensitivity, is only indicated in patients with MRI contraindications. Bone densitometry (DXA) should be obtained in patients with fragility fractures. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by 4 multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.