A 78-year-old woman fell at home and presented with left hip pain. On examination, her left hip was tender to touch and externally rotated and shortened, consistent with a femoral neck fracture. She will need pain control, evaluation for potential medical causes of the fall, orthopedic consultation, and operative management given the risks of increased mortality associated with delays in surgical repair for hip fractures in elderly patients.

2.  H&P  PE
 78 yo WF fall at home.  VS: Afebrile. P 94, BP
States she was walking in 135/93, Pox 97% RA
her house when she lost  Gen: Elderly, thin,
her balance and fell appears to be in pain
landing on her left hip.  Ext: LLE hip is TTP and
She did not hit her head leg appears externally
and denies LOC, but c/o rotated and shortened
left hip pain

5.  Pain control
 Consider eval for medical causes of fall; ie MI,
dysrythmias, CVA
 Early ortho consult
 Operative management

6.  Femoral neck fractures can also be seen in high
velocity trauma in younger patient and less commonly
as stress fractures in athletes
 Hip fractures in the elderly are associated with high
mortality in the first year after the injury.
 Delay of operative repair greater than 48 hours is also
associated with increased mortality

8.  Davenport, M et al. “Hip Fracture in Emergency
Medicine”. Emedicine.com. 9/2010.
 Truong, H et al. “Femoral Neck Fracture imaging”.
Emedicine.com 5/2011
 Tininalli, J et al. “Emergency Medicine: A
Comprehensive Study Guide”. 6th ed. 2003
 Wheeless, C. “Fracutures of the Femoral Neck”.
Wheelessonline.com. 7/2010