True AP Hip Position	AP Hip Leg Externally Rotated
With the patient's leg internally rotated there is maximum visualisation of the femoral neck	With the patient's leg externally rolled the trochanters are superimposed over the femoral neck.

Comment.

It is commonly necessary for the radiographer to start a trauma hip X-ray examination on the assumption that the patient has a NOF or other hip/pelvis fracture. It is therefore not initially appropriate for the radiographer to internally rotate the patient's affected leg for the AP hip/AP pelvis view. If the AP hip/AP pelvis image does not clearly demonstrate a fracture, and there is no evidence of other fracture of the affected leg, it may be appropriate to internally rotate the effected leg with the patient's consent and repeat the view. Radiographers are sometimes criticised for not internally rotating a ?NOF patent's affected leg, when in fact it was appropriate not to do so for the initial imaging.

This is a common appearance in patients with neck of femur fractures. The right leg is foreshortened and externally rotated. This appearance is not pathognomonic of a neck of femur fracture. This patient fell onto her right hip and did not have a NOF fracture evident on radiographic examination. As is often the case with clinical appearances, they should be considered to represent an increased chanceindicative of a fracture, not a diagnosisdiagnosic of a fracture.

Patients with neck of femur fractures commonly present with a history of falling over one leg shortened and externally rotated patients are commonlyusually elderly Patients are commonly referred for ?NOF fracture hip radiography despite the fact that the patient does not have a neck of femur re previous hip replacement surgery. These are commonly patients who have not been examined by the referring doctor. Radiographers should provide encouragement to the referring doctors to examine their patients prior to referring them for radiography. A sound clinical examination (when possible) will help to ensure appropriate and economial radiography.