SET T0032 -
Emergency Department -
Hips

Impacted fracture of the neck of the right femur.

Observations:

• Slight step in the superior cortex of the femoral neck. Red arrow.
• Sclerotic (ie dense) line running across the neck. This density is due to the impacted bone.
• Note the difference in appearance between the left and right femoral necks in the this region. 

The fracture is not shown (ie it is not visible) on the lateral view.

Fracture through the right acetabulum; minimal displacement.

Normal alignment of the prosthesis. The femur is intact.

No abnormality.

Severe degenerative disease at the left hip . . . ie loss of joint space and osteophytes. No evidence of a fracture.

Comments:

• Note the differences between this particular case and the earlier case (1) from this set.
• Sometimes it can be difficult to identify a fracture in somebody with degenerative change at the hip joint.
• In this patient the sclerotic (dense) line running across the neck of the left femur is much smoother and well demarcated than the sclerotic line which was evident in case (1). Also, there is disruption to the superior cortex of the femoral neck in case (1); in this case the same cortex is normal.

A low threshold for proceeding to cross sectional imaging should be the rule - whenever the radiographs appear normal despite a high degree of clinical concern. There will be occasions (a few) when a femoral neck fracture occurs without any displacement or impaction . . .  and the fracture is simply not visible. Clinical concern/intuition should always be the driver in relation to obtaining additional imaging.