Endgames Case Review

Hip pain after a fall

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4785 (Published 22 September 2015) Cite this as: BMJ 2015;351:h4785
  1. Michael P Barrett, specialist trainee year 4, trauma and orthopaedics1,
  2. Stephen M McDonnell, locum consultant trauma and orthopaedic surgeon2
  1. 1Ipswich Hospital NHS Trust, Ipswich IP4 5PD, UK
  2. 2Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK
  1. Correspondence to: M Barrett m.barrett1{at}nhs.net

A 60 year old woman was seen in the emergency department after she fell while playing badminton. She was unable to get up from the floor owing to pain in her right groin and was unable to weight bear with the paramedic crew. On examination, her lower limb was shortened and externally rotated. She had no comorbidities and normally mobilised independently without mobility aids. She lived in a bungalow with her husband and was independent with her activities of daily living. An anterioposterior radiograph of the pelvis was performed (figure).

Questions

  • 1. From the radiograph what is the diagnosis and how would you classify this type of injury?

  • 2. What is the blood supply to the hip joint and why is it relevant to the management of this fracture?

  • 3. How would you manage this patient?

  • 4. What further investigations are necessary in this woman?

Answers

1. From the radiograph what is the diagnosis and how would you classify this type of injury?

Short answer

Right displaced intracapsular femoral neck fracture. The low energy mechanism of injury suggests a fragility fracture.

Discussion

The radiograph shows a right femoral neck fracture. Femoral neck fractures are classified as intracapsular or extracapsular. The capsule of the hip joint surrounds the femoral neck. The capsule is attached to the acetabular rim and extends along the …

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