Pelvic Fracture After a Fall - Not Always As Simple As It Looks

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?

What happened?

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.

References

Occult Hip Fracture. NEJM, 12/2008.

Published: 03/11/2004
Updated: 06/01/2010

4 comments:

  1. The fracture line that is obvious is the ischial ramus fracture-- the post part of the 'doughnut' formed by the pubic ramus and the ischium formin the obturator foramen. A pelvic fracture like this always has two brakes. In this case it looks like the patient has avulsed the ant pubic ramus from the symphysis. patients like her, especially when they deny prior injury, may present with pain suggestive of cystitis, diverticulitis and other non-bony complaints.

    Lourdes C. Corman, MD
    Rheumatologist

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  2. I fell from my horse in Oct. 09. When I went to the Dr. I had an MRI of my back and a CT done. I was diagnosed with Piriformis Syndrom and a fractured coccyx bone. I have fractured my coccyx 3 times previously and I don't believe there is a new fracture. There is NO pain in my coccyx. I do; however, have excrutiating pain when attempting to walk and have to have my knee bent in a certain way to get any sort of relief while sleeping. I have been getting worse, and PT is not helping; I always leave by far worse then when I'd come in. I'm worried that I either dislocated my hip or have a hip fracture that was missed. I'm not even sure they looked directly in that area. I'm swollen on the left side from my ribs to about 2 inches above my knee, my leg is light purple in the morning, walking is near impossible, and my left hip does not want to follow (without throughing a massive pain fit)when attempting to change possition in bed. Does anyone have any advise that might help?

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  3. Rebekah If you haven't seen a sports medicine orthopedic doctor that would be my suggestion. I am an emergency room nurse and can tell you the tests are only as good as the doctor reading them and swelling and other issues can obstruct their vision of "hiding" fractures. But sports medicine doctors are used to injuries, such as yours. Good Luck

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  4. My point exactly. You really must see a physician. No advice provided on any website can replace seeing a doctor in person.

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