Hip Fracture Clinical Presentation

Updated: Jan 22, 2015
  • Author: Naveenpal S Bhatti, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Presentation

History

Patients with hip fractures may present in a variety of ways, ranging from an 80-year-old woman reporting hip pain after a trivial fall to a 30-year-old man in hemorrhagic shock after a high-speed motor vehicle accident.

Stress fractures usually manifest more insidiously, with an otherwise healthy person reporting pain related to activity and not healing with the conservative treatments suggested by their primary care doctor.

Although the classic presentation of a hip fracture is an elderly patient who is in extreme pain, a young, healthy athlete usually has the same presentation. The affected leg is externally rotated and may be shortened. The extremity shortening occurs because the muscles acting on the hip joint depend on the continuity of the femur to act, and when this continuity is disrupted, the result is a shorter-appearing leg. Assessing peripheral pulses and checking Doppler pressures to assure vascular patency is very important.

The patient with a stress fracture may present more subtly, reporting pain in the anterior groin or thigh. This pain increases with activity and can persist for hours afterward. The pain can progress to a point of consistency, even without activity. This pain generally expresses itself in the groin; however, it can also be referred to the knee. An antalgic gait pattern is often present. Signs and symptoms usually involve a diffuse or localized aching pain in the anterior groin or thigh region during weight-bearing activities that is relieved with rest. Night pain is also common.

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Physical

Findings of the physical evaluation of the patient with a hip fracture may include the following:

  • Testing reveals a painful hip with limited range of motion, especially in internal rotation.
  • Pain is noted upon attempted passive hip motion. The heel percussion test also produces pain. Placing a tuning fork over the affected hip may also produce pain
  • Ecchymosis may or may not be present.
  • An antalgic gait pattern may be present.
  • Deep palpation in the inguinal area produces discomfort. Tenderness to palpation is noted over the femoral neck. This area may also be swollen.
  • Increased pain on the extremes of hip rotation, an abduction lurch, and an inability to stand on the involved leg may indicate a femoral neck stress fracture. If a femoral neck stress fracture is suggested, it must be excluded. Missing this diagnosis could lead to a completely displaced femoral neck fracture, AVN, nonunion of the bone, and eventual varus deformity.
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Causes

Factors such as muscle fatigue, (which leads to abnormal gait patterns and altered stress distribution), training errors, improper footwear, and poor training surfaces can predispose an athlete to the development of stress fractures.

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