Fractured Hip versus Ruptured Disk/Sciatica?I was wondering what the differential diagnosis would be if you were presented with an 82yr old female who fell a week ago, (-) x-rays for hip fracture, c/o lower back and left leg pain, pain score 8/10, on an oral CII with little/ no little relief ? Specifically, how would a hip fx present differently from an L4/5 ruptured disk + acute sciatica? (this is for a case study, not an actual patient). Thank-you!
EDIT: In this case, the injury would have been only 2-3 days. The question that was put to me: what would you do, and I figured an MRI if the X-Rays came back (-), since clearly the narcs weren't working. What in fact happened was that the Radiologist missed the fracture on the first set of images, then caught it on the repeat.
Andrea
A hip fracture will 99% of the time show up on Xray, and the pain would be in the groin or the upper portion of the leg, the pain would be deep and she would be unable to stand to put any weight on it. Unlikely for an 82 yo to have a ruptured disc, more likely than not it would be stenosis, but symptoms would be same/similar. The nerve pain from back problems radiates, and is pain in the muscles and tissue, where the fracture would be deep pain in the bone. You mention that the CII medication is not controlling pain, how long has the patient been on them? Hope this helps
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