Musculoskeletal case studies for medical students

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History

A 58 year old female injured in a motor vehicle accident.

She complained of left hip pain. She had previous pulmonary tuberculosis, but was in good general health.

There were no other injuries.
Initial X ray
Description AP X ray Pelvis
X ray
Description Lateral X ray
Problem The 58 year old female with left hip pain after an accident. What is your diagnosis and how would you confirm it. Read how this was treated, and why.
X ray after treatment
Description After ORIF with cannulated screws.
Post management further view
Description
Classification There is an undisplaced fracture of the left femoral neck.
Discussion of management Suspect a hip fracture in an older patient who experiences hip pain after trauma. If a fracture of the femoral neck or intra trochanteric region is not seen, examine the pelvis carefully for fractures. Other imaging studies may be needed to see an occult hip fracture, such as a technetium scan or computer tomogramme. A Magnetic resonance study, although expensive, is a sensitive test for occult fractures in the hip region. If missed the occult fracture will invariably displace over the next few weeks. This femur neck fracture was undisplaced and was thus fixed in situ with cannulated pins.

 

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