Not always as simple as it looks - Pelvic fracture

95 yo CF was directly admitted to the hospital after she slipped and fell at home.
PMH: In relatively good health for 95 yo, working part time as an optometrist, independent, drives. Remote h/o uterine and colon CA.

She is c/o pain in the right side of the body. A series of X-rays were done - head, neck, shoulder, elbow, hand, hip, pelvis, knee, and ankle. You name it...

Is there a fracture?


Hip Fx; Close-up views

Right pelvic bone fracture - follow the bone contour and you will see the break in the smooth line - this is the fracture.

Patient had stable VS, power 5/5 (B).

Is everything OK?
She had slightly slurred speech and right facial droop. Is it "normal" for her - she's 95 after all...

What happened?
Slurred speech and droop resolved spontaneously in less than 24 hours. MRI of the brain did not show any acute events.

Diagnosis:
TIA
Right pelvic fracture

Follow-up:
She was D/C to an assisted living facility in good spirits. Pain was controlled with analgesics and she was walking with a walker.

What did we learn from this case?
Things may not be as simple as they seem.
Always do a full assessment of the patient no matter what the cief complaint is.
Otherwise we could have missed the TIA episode.

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