An Emergency Medicine Consultant with decades in the trenches of A&E at the Royal Lancaster Infirmary. With over four decades of experience, Ray has helped shape the department, cared for thousands of patients, mentored generations of clinicians and became a constant presence in a rapidly changing NHS.
This lady in her early 80’s fell on the Medical Ward. X rays of femurs and pelvis along with CT head were reported as normal.Eventually transferred to Community Hospital for rehabilitation
Not mobilizing so X ray of the left hip repeated after 9 days showing the missed and now displaced inter trochanteric fracture.
Lesson
Over 4 % of hip fractures may not be demonstrated on plain films (occult fractures), so if index of suspicion is high along with difficulty mobilizing proceed to CT.
Pain on weight bearing should be a RED FLAG. Patients can walk on an impacted hip fracture, something our OT Teams are not always aware of.
Though remember even a CT may occasionally miss a fracture and MRI is the Gold Standard
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