Author: V. Dimov, M.D.
Reviewer: S. Randhawa, M.D.
A 90-year-old Caucasian female (CF) was directly admitted to the hospital after she slipped and fell at home.
Past medical history (PMH)
In a relatively good health for a 90-year-old, working part-time as an optometrist, independent, drives her own car. Remote history of (h/o) uterine and colon cancer.
She was complaining of pain in the right side of the body. A series of X-rays were done -- head, neck, shoulders, elbows, hands, hips, pelvis, knees, and ankles.
Is there a fracture?
X-ray of hip Fx; Close-up views (click to enlarge the images).
The patient had a right pelvic bone fracture -- follow the bone contour and you will see the break in the smooth line -- this is the fracture.
Patient had stable vital signs, motor power was 5/5 bilaterally (B).
Is everything at baseline?
She had a slightly slurred speech and a right facial droop. Is it "normal" for her?
The slurred speech and facial droop resolved spontaneously in less than 24 hours. MRI of the brain did not show any acute events.
What is the most likely diagnosis?
Transient ischemic attack (TIA)?
Right pelvic fracture?
What happened next?
The patient was discharged to an assisted living facility in good spirits. Her pain was controlled with analgesics and she was walking with a walker on discharge.
What did we learn from this case?
Things may not be as simple as they seem. Always perform a full assessment of the patient, no matter what the chief complaint is. If you had not done so in this particular case, we would have missed the TIA episode.
Occult Hip Fracture. NEJM, 12/2008.