Date of clerking: 4th Sept 2019 Date of admission: 2nd Sept 2019

Case Summary
Mrs Mary PK, 76 years old, Indian lady, presented with pain and unable to ambulate her left hip
followed an alleged fall from a chair in sitting position. The height of the chair is about 1 meter from
the ground. She only injured her left hip and did not has any head injury and loss of consciousness after
the fall. She claimed that she was unable to move her left leg due to the severe pain, but the sensation
was intact and no open wound was noted. She has type II diabetes mellitus, hypertension, and
dyslipidemia. She was on medications and is compliant to it. There is no family history of malignancy,
and no known drug allergy She is a retired teacher and lives in a double-storey house with her elder
daughter after her husband has passed away. She enjoys gardening and cooking at home.
General examination showed she was immobilised with skin traction applied on her left hip. Her vital
signs were normal. On examination of the lower limbs, the left lower limb was cold. Capillary refill
time was adequate; pulses were felt on both lower limbs. the sensations and proprioception were intact
on both sides.
Provisional diagnosis: Neck of left femur fracture
Differential diagnosis:
1) Shaft of the left femur fracture
2) Hip dislocation
Investigation: 1) X-ray of the AP pelvis; AP and lateral of the left hip, full length of femur; CXR
Management: 1) T. PCM 1g QID 2) T. Tramadol 50mg TDS 3) Apply skin traction
Final diagnosis: Closed left femur subtrochanteric fracture
Learning outcomes:
1. Application of basic science: Intracapsular and extracapsular hip fracture
2. Critical thinking, problem-solving and research: Atypical femoral fracture with long term
bisphosphonate