Had another patient arrive by ambulance with hip pain after falling on the ice. We seem to be getting a lot of hip pain patients lately.
Pain prevented him from walking. We got x-rays that the radiologist read as normal. But the patient still couldn’t walk. Look at the x-rays and see if you can find the problem. Scroll down for the answer.
I just realized that the program I use to display the pictures won’t separate pictures within a post – they all get lumped into one gallery. So when you view the pictures in the gallery, only look at the first three pictures if you don’t want to spoil the answer.
The angle of the femur seemed odd on one of the hip x-rays and there appeared to be a linear lucency through the base of the femoral neck. The radiologist thought that the lucency was just shadows, but we had the advantage of being able to examine the patient. Since he couldn’t bear weight on that leg and since he had pain when his leg was log-rolled, we had a suspicion that there was something more than a bruise or a strain going on. So we got a CT scan. The results are below.
Femoral neck fracture.
The radiologist called back and profusely thanked us for being diligent. It wasn’t like we could send the patient home unable to walk, so a CT scan wasn’t that much of a leap in testing.
The point of the post is NOT to bust on radiologists. This is a team sport, so we help each other out. They catch as many of our misses as we catch of theirs.
But a good physical exam can make you a lot more suspicious about equivocal x-ray findings.
Now here’s a good review article by Dr. Thomas Byrd about physical examination of the hip. Know this stuff and you’ll be ahead of the game.