Figure 3

Figure 4

"I WAS BITTEN BY A DOG"

Hardick Sony, MD and Chat V. Dang, MD

ANSWER :

Figure 1 shows no cortical violation of the tibia and fibula.

Figure 3 shows Garden I fracture-incomplete or impacted fracture of the femoral neck (arrow in figure 3), in which the trabeculae of the inferior neck is still intact

DISCUSSION:

Elderly patients with relatively minor trauma may have serious pathology. In this case, the index of suspicion was high despite the patient being able to ambulate. This patient also had left groin pain, which should alert the examiner to inspect the hip more closely. Elderly patients with hip fractures have high morbidity and mortality. Complications include non-union, infection, emboli, and avascular necrosis. Therefore it is imperative not to miss hip fractures. In case of clinical suspicion of a fracture of the neck of the femur with equivocal plain radiographs, a CT scan of the hip should be obtained to rule out a fracture.

This patient had a Garden I fracture in which the inferior femoral neck is still intact. Orthopedic consultation was obtained and the patient underwent fixation with cannulated screws of the femoral neck (figure 4).

TAKE HOME POINTS:

• Maintain high suspicion of hip fractures in elderly with minor falls.
• Ability to ambulate does not preclude the presence of a hip fracture
• High suspicion of fracture of the neck of the femur with negative plain films warrants a CT scan

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