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An 80 year old woman who fell in her home

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4839 (Published 03 December 2009) Cite this as: BMJ 2009;339:b4839
  1. Frede Frihagen, consultant1,
  2. Lars Nordsletten, professor12,
  3. Roald Bahr, professor3
  1. 1Orthopaedic Centre, Oslo University Hospital, 0407 Oslo, Norway
  2. 2Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
  3. 3Roald Bahr, Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sport Sciences, 0806 Oslo, Norway
  1. Correspondence to: F Frihagen j.f.frihagen{at}medisin.uio.no

    An 80 year old woman was brought to the hospital after falling in her home. She stumbled and landed on her right hip on her way to the bathroom. After the fall she could not get up because of hip pain and inability to control her right leg. She managed to crawl to the telephone and call her daughter. Clinical examination showed shortening and external rotation of the right leg, inability to actively move the leg, and pain, especially groin pain, on passive movement.

    She lived independently in a two storey house with the bedroom upstairs. She had been a smoker for 50 years and had hypothyroidism, which had been treated with levothyroxine substitution for more than 20 years. Hypertension was treated with enalapril 5 mg daily and pravastatin 40 mg daily, and she took citalopram 20 mg daily for depression. In the winter of 2004 she had sustained a left side trochanteric fracture after falling on a slippery pavement. She was then operated on with a sliding hip screw and plate.

    We obtained an anteroposterior radiograph of the pelvis (fig 1⇓) and a lateral radiograph of the right hip.

    Fig 1 Anteroposterior radiograph of the right hip taken on admission

    Questions

    • 1 What is the diagnosis?

    • 2 What treatment would you recommend?

    • 3 How could this have been avoided?

    • 4 Is she a typical patient for this condition?

    • 5 What surgical and other complications may be a concern?

    Answers

    Short answers

    • 1 She has a hip fracture—specifically, a displaced fracture of the femoral neck. The fracture is intracapsular or medial (fig 2⇓).

    Fig 2 Anteroposterior radiograph of the right hip taken at admission showing a displaced intracapsular fracture of the femoral neck. The white arrow shows the fracture line in the proximal (head) fragment; note that the fracture is subcapital. …

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