Incidental hip fracture in an outpatient clinic: the importance of patient-centred assessment
Lloyd David Hughes 1 , Gavin Love 21 Kelty Medical Practice, NHS Fife, Kelty, UK
2 University of Dundee and Ninewells Hospital Medical School, NHS Tayside, Dundee, UK
Correspondence to: Lloyd Hughes, Kelty Medical Practice, NHS Fife, Kelty, UK. Email: L.D.Hughes@dundee.ac.uk
Journal of Primary Health Care 10(2) 176-178 https://doi.org/10.1071/HC17087
Published: 28 June 2018
Journal Compilation © Royal New Zealand College of General Practitioners 2018.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
Although many patients presenting with hip fractures have classic symptoms, other patients may present atypically with referred knee pain and reasonably unremarkable clinical examination following initial presentation. Older patients commonly have comorbid conditions such as arthritis, stroke and dementia that can complicate history and examination, making the diagnosis of subtle fractures difficult. Multimorbidity represents an important diagnostic challenge to both primary and secondary care. This case study discusses a 90-year-old lady who was found to have an old right neck of femur fracture after attendance at an geriatric outpatient clinic for a discussion about anticoagulation, after GP referral.
References
[1] van de Ree CLP, De Jongh MAC, Peeters CMM,, et al. Hip fractures in elderly people: surgery or no surgery? A systematic review and meta-analysis. Geriatr Orthop Surg Rehabil. 2017; 8 173–80.| Hip fractures in elderly people: surgery or no surgery? A systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[2] Beaupre LA, Jones CA, Saunders DL,, et al. Best practices for elderly hip fracture patients - a systematic overview of the evidence. J Gen Intern Med. 2005; 20 1019–25.
| Best practices for elderly hip fracture patients - a systematic overview of the evidence.Crossref | GoogleScholarGoogle Scholar |
[3] Maggi S, Kelsey JL, Litvak J,, et al. Incidence of hip fractures in the elderly: a cross-national analysis. Osteoporos Int. 1991; 1 232–41.
| Incidence of hip fractures in the elderly: a cross-national analysis.Crossref | GoogleScholarGoogle Scholar |
[4] Brunner LC, Eshilian-Oates L, Kuo TY. Hip fractures in adults. Am Fam Physician. 2003; 67 537–42.
[5] Limpawattana P, Phungoen P, Mitsungnern T,, et al. Atypical presentations of older adults at the emergency department and associated factors. Arch Gerontol Geriatr. 2016; 62 97–102.
| Atypical presentations of older adults at the emergency department and associated factors.Crossref | GoogleScholarGoogle Scholar |
[6] Hofmann A, Wyatt R. Missed subcapital fractures. Ann Emerg Med. 1984; 13 951–5.
| Missed subcapital fractures.Crossref | GoogleScholarGoogle Scholar |
[7] Miller D, Meyer C, Perkins C. A barn door: fractured neck of femur. J Orthoped Surg. 2005; 3 2.
[8] Parker MJ. Missed hip fractures. Arch Emerg Med. 1992; 9 23–7.
| Missed hip fractures.Crossref | GoogleScholarGoogle Scholar |
[9] Eastwood HD. Delayed diagnosis of femoral-neck fractures in the elderly. Age Ageing. 1987; 16 378–82.
| Delayed diagnosis of femoral-neck fractures in the elderly.Crossref | GoogleScholarGoogle Scholar |
[10] Hughes LD, McMurdo ME, Guthrie B. Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity. Age Ageing. 2013; 42 62–9.
| Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity.Crossref | GoogleScholarGoogle Scholar |
[11] Uijen AA, van de Lisdonk EH. Multimorbidity in primary care: prevalence and trend over the last 20 years. Eur J Gen Pract. 2008; 14 28–32.
| Multimorbidity in primary care: prevalence and trend over the last 20 years.Crossref | GoogleScholarGoogle Scholar |
[12] Scottish Government, NHS Scotland. Polypharmacy Guidance. Edinburgh: Scottish Goverment; 2015 [cited 2018 March 12]. Available from: http://www.sehd.scot.nhs.uk/publications/DC20150415polypharmacy.pdf
[13] Mangin D, Heath I, Jamoulle M. Beyond diagnosis: rising to the multimorbidity challenge. BMJ 2012; 344 e3526
| Beyond diagnosis: rising to the multimorbidity challenge.Crossref | GoogleScholarGoogle Scholar |
