An 84F, w/ AZ dementia presents to the ED for evaluation after refusing to get out of bed. She has been known to wander the halls at her facility, & a nursing aide reported finding her on the floor next to her bed earlier that day. Vitals are normal. On exam, the pt is in pain. Her right leg appears shorter than the left leg. She is able to wiggle her toes but has sig external rotation of the RLE compared to the left. There is no evidence of head trauma & the lower leg compartments are soft.

Which of the following is the most likely Dx?

(Femoral neck fracture

OR

Posterior hip dislocation)

Question

18-05-2024
Medicine

College

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An 84F, w/ AZ dementia presents to the ED for evaluation after refusing to get out of bed. She has been known to wander the halls at her facility, & a nursing aide reported finding her on the floor next to her bed earlier that day. Vitals are normal. On exam, the pt is in pain. Her right leg appears shorter than the left leg. She is able to wiggle her toes but has sig external rotation of the RLE compared to the left. There is no evidence of head trauma & the lower leg compartments are soft.

Which of the following is the most likely Dx?

(Femoral neck fracture

OR

Posterior hip dislocation)

Answer :

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reetukatiyar26 reetukatiyar26 · Answer 1 · 2023-10-04T19:05:53-04:00

Final answer:

The patient's symptoms suggest a femoral neck fracture, which is characterized by leg pain, changes in leg length, and external rotation.

Explanation:

In this clinical scenario, an 84F, w/ AZ dementia presents to the ED for evaluation after refusing to get out of bed. She has been found on the floor once by a nurse and her right leg appears shorter than the left with significant external rotation. The pain she's experiencing, the changed leg length and external rotation are classic signs of a femoral neck fracture. A posterior hip dislocation is less likely as it typically occurs after a traumatic injury. In addition, it often presents with the leg in internal rotation, not external rotation. Hence, the most probable diagnosis in this case would be a femoral neck fracture.

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