Diagnosing Hip & Pelvic Fractures

Orthopedic specialists at NYU Langone diagnose many types of fractures in the hip or pelvis. Using imaging tests, they can determine the location of a fracture, how many bones are affected, and whether an injury has damaged surrounding soft tissues, such as tendons, ligaments, blood vessels, or nerves.

Most hip and pelvic fractures require immediate medical care. Often, doctors perform surgery to set and stabilize the bone to prevent permanent damage. If you have been injured and feel pain in the hip or pelvis, our doctors recommend going to the nearest emergency room.

Hip and pelvic fractures usually occur as the result of a fall or high-energy impact, such as a car accident or fall from a great height. In people older than age 60, hip and pelvic fractures are very common injuries, especially in women who have osteoporosis, a condition that causes bones to become fragile. A very low-energy fall, such as tripping on the edge of a rug, may cause a bone to break in someone with osteoporosis.

In athletes, repeated high-impact activity may cause a stress fracture, which is a tiny crack in the hip or pelvic bone. In people with osteoporosis, the stress of everyday movements, such as walking and climbing stairs, may lead to a type of stress fracture called an insufficiency fracture.

Symptoms of a hip or pelvic fracture include significant, sharp pain in the hip or groin and swelling, bruising, and tenderness in the skin at the site of the injury. Depending on the severity of the fracture, a broken bone may prevent you from putting any weight on the affected hip.

Our hip experts evaluate the affected hip or pelvic bone during a physical examination and confirm the diagnosis using imaging tests.

Physical Exam

A doctor examines your hip and pelvis to assess the extent of swelling, bruising, and tenderness. He or she asks about the location and severity of pain you’re experiencing. If you have an open fracture, in which a bone pokes through the skin, the doctor diagnoses it quickly and often performs immediate surgery.

During the exam, the doctor asks how the injury occurred, how much pain you feel, and where the pain is located. He or she also asks about your medical history. Information about other medical conditions, such as osteoporosis, or previous hip injuries helps our doctors to make the best choice for your care while evaluating the injury.

Diagnostic Imaging

NYU Langone radiologists, doctors who specialize in administering and interpreting diagnostic imaging tests, work closely with orthopedic surgeons to take detailed pictures of the hip or pelvis.

X-rays

X-ray images use electromagnetic radiation to reveal the location of a fractured bone in the hip or pelvis. They also help your doctor determine if a bone is broken in more than one place and whether any bone fragments have been displaced, or moved out of position.

CT Scans

Your doctor may order a CT scan to examine a fracture pattern or assess the extent of damage in the hip joint. A CT scan uses X-rays and a computer to create two- and three-dimensional pictures of the hip and pelvic bones, enabling doctors to examine a fracture from many different angles. This test may also reveal the presence of small bone fragments, which may become lodged in the hip joint and require surgical removal.

Doctors also use CT scans after setting a broken bone to confirm that the pieces have been put back into place correctly.

MRI Scans

If a doctor suspects a stress fracture in the hip or pelvis that can’t be seen on an X-ray, or if symptoms suggest damage to ligaments, tendons, blood vessels, or nerves in addition to a fracture, your doctor may recommend an MRI. This test uses a magnetic field and radio waves to create computerized, three-dimensional images of the soft tissues surrounding the joint.

An MRI can reveal torn or strained ligaments or tendons or a bone fragment that’s pressing on a nerve. Doctors may also order an MRI if your symptoms suggest a fracture but there is no evidence of trauma on an X-ray.

Bone Scans

If you have pain and swelling that indicates a fracture but you can’t have an MRI because you have a pacemaker or other implanted medical device, your doctor may recommend a bone scan.

To perform this test, a technician injects a small amount of dye into a vein in your arm. This dye, called a tracer, travels through the bloodstream and accumulates in places where your cells and tissues are making repairs.

After the tracer has moved through the bloodstream for one or two hours, a radiologist scans your body using a special camera designed to capture images of the tracer. If it accumulates in certain places in the hip or pelvis more than others, you may have a fracture.