Which clinical history findings are characteristic of hip fractures?

Updated: Jan 08, 2019
  • Author: Naveenpal S Bhatti, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Answer

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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