She is otherwise well with no confusion. She is on warfarin for atrial fibrillation. The doctor examines her and decide to get an X-ray of her hip and pelvis.
Q1. What points in the history and examination will make you want to request an X-ray of her hip?
The X-ray appears normal and the doctor decides to discharge the patient after adequate analgesia. She normally mobilises with 2 sticks and seems to be able to take a few steps despite being in a little pain.
Q2. What percentage of fractured NOF have normal radiology findings in ED and how should this patient have been managed?
She returns to ED 1 week later still struggling to weight bear and the GP is concerned. She has a repeat X-ray which can be seen here:
Q3. Describe the X-ray findings?
Q4. How would you manage this patient?
You decide to perform a fascia iliaca block. She weighs 70kg.
Q5. What dose of local anaesthetic will you use and which agent? Explain your answer?
Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case.