When confirming a suspected femoral neck fracture in an elderly patient, which imaging study is most commonly used first?

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

Answer: (A)

When evaluating a suspected femoral neck fracture in an elderly patient, start with plain X-ray imaging of the hip and pelvis. This modality is quick, inexpensive, and widely available, providing immediate information on whether a fracture is present and, if so, its displacement and alignment. That early radiograph helps determine urgent management decisions, such as the need for surgical fixation or arthroplasty and identifying any associated injuries.

If the X-ray is negative but clinical suspicion remains high, MRI is the preferred next step because it is the most sensitive test for detecting occult femoral neck fractures. CT can be used if MRI is not available or contraindicated to offer better bone detail and assist surgical planning. Ultrasound does not effectively evaluate bony injuries like femoral neck fractures.