Limb Pain, Swelling, Traumatic Limb & Joint Injury [Case #2]

“A 82 years old lady presents to the ED after rolling out of bed at her residential home. She has been complaining of left leg pain since it happened a few hours ago but has been able to weight bear and walk with a little support.”

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:

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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.