Case 1015

Neck of femur fractureWhat is the diagnosis?

Case image 1 X-ray 1 / 2

AP pelvis radiograph.

Image: Drvaram, CC BY-SA 4.0 — source

Answer hidden. Review the images and history, decide on your diagnosis, then reveal.

Findings

  • Fracture through the right femoral neck with disruption of Shenton's line
  • Osteopenic bones
  • Post-operative film: dynamic hip screw and side plate fixing the right proximal femur

Case discussion

Hip fracture in an older person after a low-energy fall is common and carries significant mortality. Always compare Shenton's lines and the femoral neck cortices on both sides.

If films are normal but pain persists, MRI is the test for an occult fracture. Management is early surgery — fixation or arthroplasty depending on the fracture pattern — with orthogeriatric input.

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