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SONO case series: an 85-year-old woman with left hip pain
  1. William Shyy
  1. Correspondence to Dr William Shyy, Emergency Medicine, UCSF, San Francisco, CA, USA; william.shyy{at}ucsf.edu

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Case presentation

An 85-year-old woman presented with left hip pain after an unwitnessed mechanical fall. The patient was standing at home washing her face when her legs gave out and she landed onto her left hip. She was unable to stand after this accident and denies head strike or loss of consciousness. She was not on anticoagulation. When Emergency Medical Services arrived, the left leg was foreshortened and externally rotated. The paramedics administered 10 mg of intravenous morphine, but she was still writhing in pain on arrival. She presented with pain to the left hip, but with no weakness, numbness or paresthesias of the left lower extremity.

Medical history: Diabetes Mellitus, Hypertension and Chronic Kidney DiseaseK. Surgical history: none. Home medications: none. No allergies.

Triage vital signs: Blood pressure: 174/82 mm Hg, heart rate: 71 beats per minute, temperature: 36.7°C, respiration rate: 18 breaths per minute and SpO2: 96%.

Physical examination

Woman appearing frail and in pain. The head is atraumatic, but there is mild tenderness to palpation of the mid-cervical spine, c-collar is in place. Cardiac, pulmonary and abdominal examinations are normal. The left leg is foreshortened and externally rotated. There is severe tenderness to palpation of the left hip with limited range of MotionO due to pain. Circulation, sensation and movement are intact in the left leg.

The patient’s pelvic X-ray is shown in figure 1.

Figure 1

Anterior-PosteriorA pelvic X-ray demonstrates a left femoral neck fracture (arrow).

Questions

1. Why should we perform a fascia iliaca nerve block for hip fractures?

Multiple studies have shown decreased in-hospital mortality and complications when regional anaesthesia is performed. Specifically for hip fractures, fascia …

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Footnotes

  • Handling editor Simon Carley

  • Contributors Being a sole author, the author himself prepared this manuscript.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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