Causes of Misdiagnosis of Hip Fracture in the Elderly

YANG Yong; LYU Wei; CHU Bo; CHU Weiming; WU Jianyue

doi:10.3969/j.issn.1002-3429.2024.07.004

Abstract：Objective To investigate the clinical and imaging characteristics of the elderly with hip fractures and to analyze the causes of misdiagnosis.Methods A retrospective analysis was performed on clinical data of three elderly patients with hip fracture who had an initial X-ray diagnosis from January 2022 to December 2023 that did not match the final diagno-sis.Results The three patients presented to the orthopedic clinic for hip pain after a fall,and none of the three patients had a definite fracture on the hip X-ray at the first consultation.All patients were misdiagnosed with hip injuries.One patient was confirmed by radiography after hip pain was aggravated due to conservative treatment.One patient was diagnosed by CT due to hip pain that did not improve after conservative treatment,and one patient was confirmed after a further MRI examination of hip joints due to greater hip pain.Of these,2 had femoral neck fractures,including 1 receiving total hip replacement,and 1 receiving artificial dual-acting femoral replacement.One patient had intertrochanteric fracture of the femur,and underwent in-tramedullary nail fixation surgery for the proximal femur fracture.The duration of misdiagnosis of 3 patients was 1-23 d.All patients were discharged from hospital at 8-9 d after operation.Conclusion For elderly patients with hip pain in clinical practice,especially those with a history of low-violence injury,clinicians should consider the possibility of a hip fracture in the elderly according to symptoms and signs.X-ray examination should be preferred,and further CT and MRI examinations should be selected according to the patient's situation,even if the X-ray examination is negative,to avoid misdiagnosis,and allow eld-erly patients with hip fractures to have an early,definitive diagnosis and timely treatment.