MEDizzy - An 84-year-old man presented with hip pain following a fall.

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Geriatric Medicine 2

An 84-year-old man presented with hip pain following a fall. He had a background of osteoarthritis, hypertension, and diabetes mellitus. Plain X-ray imaging excluded a fracture, and he was admitted for analgesia and physiotherapy. He was given regular paracetamol, tramadol 50mg QDS, and PRN oramorph. 3 days later, the physiotherapist reported that his rehabilitation was being limited by ongoing pain on weight-bearing. What is the most appropriate next step in his management?

ExplanationNICE recommend the use of MRI in cases where the index of suspicion for fracture remains high despite negative plain films. If MRI is not available within 24hr, CT imaging should be considered. After 48hr, plain X-rays may demonstrate a previously missed fracture, owing to bone resorption or cortical displacement, but the risk of a repeat false negative persists. Radionucleotide scans may be an option, but are likely to be confounded in the presence of osteoarthritis.