The Bristol Hip View: a new hypothetical radiographic projection for femoral neck fractures

Abstract

This experimental study is to evaluate a modified radiographic view of the femoral neck in the assessment of femoral fractures. A dry femur and pelvis was set up in a rig to simulate the positioning of a routine anteroposterior (AP) pelvis X-ray view. Films were exposed to create a routine AP pelvis, AP hip and two views with external tube angulation of 15 degrees and 30 degrees. Observers were asked to evaluate the films using a visual analogue score on two separate occasions. The same films were performed on a further fractured femoral neck to assess the fracture clarity. There was good intraobserver and interobserver correlation. Observers ranked the 15 degrees and 30 degrees angled films as showing the femoral neck most clearly, over and above the traditional views (p<0.001). The fracture was best demonstrated on the 30 degrees angled film (p<0.001). The 30 degrees angled view appears to demonstrate the femoral neck anatomy more clearly than the traditional views but also showed increased fracture sharpness. The authors are proceeding to a clinical trial to assess this in trauma practice.