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G37(P) In children with hip pain or a limp, is a single frog-leg lateral x-ray sufficient to diagnose pathology?
  1. EL Lindell1,
  2. D Broomfield2,
  3. S McGurk3
  1. 1College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
  2. 2Emergency Medicine, Royal Hospital for Sick Children, Edinburgh, UK
  3. 3Radiology, Royal Hospital for Sick Children, Edinburgh, UK

Abstract

Introduction It is widely accepted that two x-ray views should be obtained in the evaluation of paediatric hip pathology; a frog-leg lateral (FLL) and an anteroposterior (AP) view. In 2009, it was postulated that a single FLL view may be sufficient. A policy was introduced stipulating that in cases of hip pathology only an FLL x-ray should be performed. This report assesses whether a single FLL x-ray is adequate and the degree of adherence to the new policy.

Method Data was collected for all patients who received AP or FLL x-rays between 1st January 2011 and 31st December 2012 inclusive for acute pathology (n = 817). Computerised records were accessed to establish whether an FLL had been sufficient, or if further imaging had been required.

Results In those receiving FLL x-rays (n = 392), only 8 cases required further plain x-ray imaging of the pelvis, equivalent to 2.04%. Of these, in only one case was bony pathology visualised on subsequent AP, but not on the initial FLL. In this one case an insufficiency fracture was detected on MRI, therefore as the AP view was performed after an interval, it is difficult to ascertain whether this would have been picked up prospectively.

Conclusion A single FLL x-ray appears adequate to diagnose hip pathology, therefore halving the radiation exposure to a child’s pelvis and reducing the risk of future morbidity.

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