Delayed Diagnosis of Hip Fracture Causes Avascular Necrosis

Patients with hip fracture typically present to the emergency department or their physician’s office after a fall. They are often unable to walk, and they may exhibit shortening and external rotation of the affected limb. Frequently, they have hip pain. In some instances, however, patients with hip fracture may complain only of vague pain in their buttocks, knees, thighs, groin, or back. Their ability to walk may be unaffected, and initial radiographic findings may be indeterminate. In these patients, additional studies, such as magnetic resonance imaging or bone scanning, may be necessary to confirm the presence of a hip fracture. A high index of suspicion often is required for prompt diagnosis and treatment of an occult hip fracture but at the very minimum, a physician must give the patient a full physical exam to rule out such causes before sending a patient home. Simply allowing a PA to see the patient and promptly discharge would be inadequate.