Patient history: It is important to ascertain the mechanism behind a patients fall, so clinical assessment should focus on identifying any preceding symptoms. The term ‘mechanical fall’ is not favoured amongst teams who care for elderly patients regularly as it does not accurately characterise the nature of a fall. Important causes including cardiac dysrhythmia, postural hypotension and infection should not be missed. There is not always history of a fall. Sometimes there has been a fall that the patient cannot remember (e.g. as a result of dementia) or describe (e.g. due to dysphasia). However, some fractures may occur spontaneously.

Classical deformity: The classical deformity resulting from a fall is that the leg is shortened and externally rotated, but 15% of fractures are impacted and there will be no deformity. Any elderly person who complains of hip pain or is unable to mobilise at their normal level of mobility, even without a history of a fall, should have an x-ray of the hip.

Learning bite

Have a very low threshold for x-rays of the hip if there is the slightest possibility of a fractured neck of femur.

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