Author: Shoaib Mahboob / Editor: Stephen Sheridan / Codes: ELC5, ElC6, ELP2, SLO1, TP6 / Published: 18/06/2026
A 78-year-old woman presents to the emergency department (ED) with sudden onset severe right groin pain. The pain occurs whilst she attempts to stand from her sofa. She is completely unable to weight-bear.
Her past medical history includes Parkinson’s disease, atrial fibrillation, temporal lobe epilepsy, hypertension and chronic kidney disease. Her regular medications include apixaban, sodium valproate, lamotrigine, levodopa with carbidopa, lansoprazole, cholecalciferol and cinacalcet.
On examination, vital signs are stable. The right hip is tender with passive internal and external rotation and with axial loading. There is no leg length discrepancy or external rotation deformity. No bruising or swelling is evident. Neurovascular examination is intact.
Plain radiographs of the right hip show no acute bony injury. Computed tomography (CT) demonstrates no fracture but reveals a mild joint effusion. Despite analgesia, she remains completely unable to weight-bear with severe mechanical hip pain.
Given her inability to mobilize, severe mechanical symptoms, and multiple risk factors for bone fragility, clinical suspicion of an occult fracture remains high.
3 responses
Quite Worrying Things and Easily Missed
Thanks