A old lady comes to you with history of fall in washroom and pain in gluteal region, limb is in lateral rotation. you did a X-ray pelvis which is found normal, Pain persists even after 24 hours, next step is?
Simple X-rays (anteroposterior and lateral) of the hip diagnose fracture in the majority of cases. In patients with pain in the hip and an inability to weight-bear with no fracture apparent on plain X-rays, fuher investigation is required. MRI is the most sensitive and specific to diagnose an occult hip fracture, although CT is often readily accessible and sufficient to detect most fractures of the femoral neck or elsewhere in the pelvic ring. If MRI is not available rapidly, CT is preferred. Occult fractures are detected in 50% of patients with normal X-rays and ongoing pain that prevents weight-bearing with additional imaging. Bone scans could be considered if MRI or CT scans are not available.
Closed reduction under general anesthesia
Rules out the possibility of a fracture, so send the patient home with analgesics for pain
Bone scan within the next 72 hours
MRI in 24 hours
Pelvis and Hip Injury