EM Forum Case #99 "Can't Walk, Can’t
Go"
by Charlene Babcock Irvin, MD, FACEP
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A 62 y/o female presents with pain in her right hip after she fell this morning. She is unable to bear weight because of the pain. She had her daughter call 911 to help her get to the hospital. She did not strike her head, and there was no loss of consciousness.
PMH: Diabetes, heart attack years ago, stent last year. No surgeries, no previous fractures.
Meds: Glucophage, metoprolol, and aspirin.
PE: Thin female, lying still on gurney.
HR=78, RR=20, BP=158/85, Temp: afebrile, Sat 96% on RA.
HEENT: No evidence for trauma, PERRL, Neck supple, full ROM without any pain.
HEART: RRR, no Murmurs, or gallops.
Lungs: Clear bilaterally.
Abd: Soft, nontender, unremarkable. No masses.
Ext: Pain at right hip. ROM limited by pain. Leg is not shortened or rotated. Pulses normal and present.
Pain medication is administered, and an X-Ray of the hip is obtained, which is read by the radiologist as normal.
Questions:
1. How often are hip fractures missed on the original x-ray?
2. If she turns out to have a hip fracture, what is her mortality rate?
3. What is the Patellar-Pubic Percussion Test? How sensitive is it? What is Shenton’s line?
4. What questions did I fail to ask?
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