Question

A 47 yr old female computer engineer who is remodelling her home while working from home arrives in the Emergency Department immediately after having tripped over a ladder causing a brick that was on the ladder to fall on her right hip (just lateral to the ASIS). She has normal gait. She has not noticed any changes in bowel or urinary function. She is not pregnant. She complains of severe right hip pain and pain on extension of her right hip as well as pain on lifting her left knee to her abdomen. She is afraid that the brick broke her hip bone. She has no other pertinent past medical history. You administer a pregnancy test which is negative and take Anterior/posterior and lateral views of the right hip and pelvis. THey are unremarkable.

1) Do you have any differential diagnosis? 2) What are your next steps? Any further diagnostic tests now? Later?

Answer 1

If patient has   a normal gait and all x-rays are normal that means patient is free of disease in her initiall assessment

Howevwe there are several cases reported clinically that some injuries cannot detect with the help of xrays

they need further investigations like

CT scan(COMPUTED TOMOGRAPHY) to detect any internal bleeding ,small broken bones

OR

MRI scan (MAGNETIC RESONANCE IMAGING)

it work using a magnetic field and radio wave pulses to produce clear images of internal body part

THERFORE cartilage and muscle tear also can identify in MRI scan

initially this patient can be treated with some pain medications to increase her level of comfort and then go for further scaning to find presence of other injuries  

Provide comfort to the pillows

clear all concerns

assess the site for any abnormalities

if pain is prevalent go for CT SCAN OR MRI SCAN