An old lady had a history of fall in bathroom once and couldn't move. Afterwards, she had led in externally rotated position. There was tenderness in Scarpa's triangle and limb movement could not been done due to pain. No hip fracture was seen on X-ray. Next step
A i.e. MRI - If the diagnosis of hip fracture is questionable in an acutely pinful hip, MRI is the best imaging modality (of choice)Q with 100% sensitivity in patients with equivocal radiographic findings. It is the best imaging modaliy for non displaced (impacted) or stress fracture of femoral neck because it provides greater accuracy (than bone scan & CT), > Bone scan >> CT scan" v:shapes="_x0000_s1031">earlier diagnosis, shoer hospital stay and no exposure to radiation. MRI shows Plain X-ray decreased signal on spin echo T1WI & correspondingly increased signal as a result of (AI', lateral edema or bleeding on T2WI. It also picks up soft tissue problems that may be causing views) hip pain in absence of fracture and provides supplemental information regarding femoral head bility and presence of associated bone cyst. - Traditionally, bone scan imaging, must be delayed 48 to 72 hours in elderly and 24 to 36 most cases hours in children or adolescents, from the time of initial injury to allow increased bone metabolism to occur at the fracture site so that false negative results are avoided (which are more common osteopenic bone). - History of fall, followed by externally rotated leg, tenderness in Scarpa's triangle, . inability to move limb and bear weight indicate the diagnosis of fracture neck femur. In majority of cases plain X rays can confirm the diagnosis. But in cases with equivocal radiographic findings (showing no fracture) early confirmation of diagnosis by MRI >> bone scan >> CT scan is essential because delaying fixation increases morbidity and moality in elderly patients.
MRI
Repeat X-ray after one week
Joint aspiration
Give analgesic and manipulate