Detecting Hidden Hip Fractures

If you've sustained an injury or trauma to your hip, and have persistent pain, you need to have diagnostic testing to check for the presence of a hip fracture.
Because hip fractures are hard to diagnose with X-rays alone, further testing is necessary if patients continue to have pain.

Recently emergency rooms have seen this type of situation where a patient arrives for treatment, after an injury or fall, but the X-rays are normal even though they have a fracture.

With the prevalence of hip fractures in the elderly, we need to have additional testing available, if these X-rays don't locate a fracture, and the pain persists.
If you have normal hip X-rays but can't bear weight or the pain doesn't go away, ask for additional testing, like a CT scan or MRI.

Emergency rooms see this type of hidden hip fracture, where the patient has persistent pain from trauma, but the X-rays don't show a fracture.
If they don't find a fracture, the patient is sent home or enrolled in an elder care program that includes rehabilitation.
In some cases the symptoms may worsen if a fracture isn't treated.

To eliminate these misdiagnoses, emergency rooms implemented a clinical triad of signs that they use to determine the extent of the injury.
Below is an explanation of these symptoms.

The clinical triad includes:

  1. Inability to straight leg lift

  2. Limitation of rotation due to hip pain

  3. Groin tenderness with deep palpation

If a patient has some or all of these signs, the hospital would order additional testing to get a better view of the area with MRI or CT scan.
If these imaging studies find a femoral neck fracture proper fracture treatment begins.

When the Doctors see all three signs, the patient has a definite fracture.
If the patients present with two signs, they may have a fracture.
When the patient has one sign they may have hip arthritis, avascular necrosis, or possibly synovitis, which is an inflammation of the synovial membrane.

Some insurance companies will not pay for additional testing when the initial X-ray is normal, so using this triad will help to justify further testing and
prevent the problems that could occur if the patient was sent home, or to elder care with an undiagnosed fracture.

To add to this problem, some clinics don't have access to imaging equipment, so X-rays are all they have to determine the extent of the injury.
With this simple checklist of symptoms, many misdiagnoses could be avoided.

If more clinics and emergency rooms use this clinical triad of signs, it would cut down on unnecessary surgical procedures, and offer faster surgical treatment for those with two or three of the limitations, that have a confirmed fracture.

Orthopedic Surgeons, Drs. Rajkumar and Tay, from the United Kingdom developed this clinical triad to correctly identify hip fractures in a pilot study from June 2004 to December 2005 at Wexham Park and Nottingham Hospitals.

Pam Flores
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Pam Flores

Pam wrote for HealthCentral as a patient expert for Osteoporosis.