Diagnosis of an Occult Hip Fracture by Point-of-Care Ultrasound

BackgroundHip fractures are common injuries, particularly among elderly patients. Although plain radiographs are the initial imaging modality of choice, approximately 10% of hip fractures are not radiographically evident. Failure to diagnose a hip fracture in the emergency department may result in delayed diagnosis and potentially devastating consequences.Case ReportWe report the case of an 81-year-old woman with right hip pain after a fall. Although plain radiographs of the right hip and femur were negative for fracture, point-of-care ultrasound of the right hip demonstrated a cortical disruption in the femur consistent with a fracture. Given the clinical and ultrasound findings, computed tomography of the bony pelvis and proximal femurs was performed, which confirmed an oblique complex fracture of the right femur through the greater and lesser trochanters.Why Should an Emergency Physician Be Aware of This?Point-of-care ultrasound, in conjunction with clinical suspicion, may help identify patients who require more advanced imaging to identify occult hip fractures.