A 68-year-old patient with a suspected hip fracture is brought to the emergency department after a fall. Which assessment finding would be most indicative of a displaced femoral neck fracture?
1Pain that increases with passive range of motion of the hip
2Inability to bear weight on the affected extremity
3External rotation and shortening of the affected leg✓ 정답
4Swelling and bruising around the hip joint
해설
External rotation and shortening of the affected leg is the classic sign of a displaced femoral neck fracture, indicating bone displacement and muscle pull. Other findings like pain with motion or swelling are less specific for this type of fracture.
Clinical Judgment
This question assesses the ability to identify the clinical sign that most specifically indicates a displaced femoral neck fracture when evaluating a suspected hip fracture after a fall in an elderly patient. The key is the condition 'displaced'. Without displacement, bone fragments remain in place, but with displacement, the fragments separate, disrupting anatomical alignment. This causes powerful hip muscles (especially the external rotators) to spasm and pull on the fractured limb, creating the classic posture of external rotation and shortening. This is a nearly pathognomonic sign that is clearly distinguishable by visual inspection.
Memory Tip: A mnemonic to remember the features of a displaced femoral neck fracture is "Foot Falls Out." The affected foot turns outward (Out) and the leg appears shortened (Foot).
KR vs US: This clinical sign is considered equally important in both Korea and the US. However, the US NGN assesses Clinical Reasoning more deeply, focusing not just on knowing the sign, but on why it occurs (anatomy, biomechanics) and how it impacts patient management (e.g., increased risk of avascular necrosis).
Clinical Practice GuideWhen evaluating an elderly patient after a fall:1. Immediately check for "external rotation and shortening." This strongly suggests the need for emergency orthopedic consultation and surgical intervention.2. Pain management: Displaced fractures are accompanied by severe pain. Check the patient's baseline status (e.g., renal function) before administering medication.3. Immobilization: Simply telling them not to move is not enough. Stabilize the position of the limb and minimize unnecessary movement.
Caution: In SATA (Select All That Apply) questions, the trap point is listing "all signs that can be seen in a hip fracture patient." If the question asks for the sign that is "most indicative" of a displaced femoral neck fracture, external rotation and shortening is the only correct answer. Other signs can also appear in non-displaced fractures or fractures of other sites.
Femoral Neck Fracture — Femoral neck fracture. A fracture of the narrow part of the femur located within the hip joint, it is a major complication of falls in the elderly and carries a high risk of avascular necrosis due to vulnerable blood supply.
Displaced Fracture — Displaced fracture. A condition where broken bone fragments have shifted out of their normal anatomical alignment. Compared to nondisplaced fractures, they are more unstable and often require surgical reduction.
External Rotation — External rotation. Movement where the limb rotates outward from the midline of the body. In displaced femoral neck fractures, spasm of the hip's external rotator muscles causes a characteristic posture where the foot and knee point outward.
Leg Shortening — Leg shortening. A condition where one leg appears shorter than the healthy side due to overriding of fracture fragments or severe joint dislocation. Confirm through measurement.
Avascular Necrosis — Avascular necrosis. A condition where the blood supply to a part of the bone is blocked, causing the bone tissue to die. It is a serious complication that can occur in the femoral head after a femoral neck fracture.