Initial test for hip fracture is which imaging modality?

• A. Hip X-ray
• B. MRI
• C. CT
• D. Ultrasound

Answer: (A)

The main idea here is that the first step in evaluating a suspected hip fracture is a plain radiograph of the hip. X-rays are fast, widely available, and inexpensive, making them the most practical screening tool in an urgent setting. They typically include an AP pelvis view and a lateral view of the hip (often a cross-table lateral). These views can detect most common fractures, such as femoral neck and intertrochanteric fractures, and they help determine immediate management.

If the X-ray shows a fracture, you proceed with definitive care based on the fracture type. If the X-ray does not show a fracture but clinical symptoms persist (pain, inability to bear weight, deformity), occult fractures remain a concern. In that situation, MRI is the preferred next step because it is the most sensitive modality for detecting occult fractures and can confirm the diagnosis without delaying treatment. CT can also be used when MRI is not available or contraindicated or when detailed fracture anatomy is needed for surgical planning. Ultrasound is not used to diagnose fractures, though it might assess surrounding soft tissue issues.

So the initial imaging choice is hip X-ray because it quickly identifies most fractures and guides urgent management. If suspicion remains after a negative X-ray, MRI becomes the next best test.