Impacted and Angulated Right Hip Fracture in a Patient Reporting No History of Trauma Presenting to a Chiropractic Physician: A Case Report

Abstract

A case involving a patient with an impacted and angulated femoral neck fracture presenting to a chiropractic physician is rare. This unique case contributes an account of a challenging differential diagnosis to the literature. A 65-year-old female, reporting no history of trauma, presented with a two-week history of right lower back and right anterior hip pain radiating down the front of the right thigh in the L2-L4 dermatome. The differential diagnosis included lumbar spine disc herniation and nerve root compression or a right hip abnormality. An MRI of the lumbar spine revealed L3-L4 and L4-L5 posterior disc bulges and right foraminal narrowing. She was subsequently referred to pain management and diagnosed with lumbar radiculopathy and neural foraminal stenosis. After three lumbar spine epidural injections and a period of conservative care, the patient's symptoms were 90% improved but not fully resolved. Subsequently, right hip X-rays were ordered. The x-rays revealed an impacted and angulated right femoral neck base fracture. At this time, the patient recalled a possible traumatic incident. The patient was immediately referred to an orthopedic surgeon. After a month's delay waiting for further advanced imaging, a total right hip replacement was performed. This case underscores the importance for physicians to recognize that patients may not be aware of their own history of trauma. It also highlights the need for physicians to consider the possibility of multiple concurrent pathologies and to order imaging for all areas of pain.

Keywords: chiropractic; diagnosis; fracture; history; imaging.