Differential Diagnosis for 60f with Fall to Left Hip

• Single most likely diagnosis
  • Intertrochanteric hip fracture: This is the most likely diagnosis given the patient's age, mechanism of injury (fall to the side), and symptoms (significant bruising and swelling). Osteoporosis is common in postmenopausal women, increasing the risk of hip fractures.
• Other Likely diagnoses
  • Femoral neck fracture: Another common type of hip fracture in elderly patients, especially after a fall. The patient's ability to walk does not rule out this diagnosis, as some patients with nondisplaced fractures may still be able to ambulate.
  • Pelvic fracture: The patient's significant bruising and swelling could also be indicative of a pelvic fracture, which can occur in elderly patients after a fall.
  • Soft tissue injury (contusion or hematoma): Given the significant bruising and swelling, a soft tissue injury is also a possible diagnosis, although less likely than a fracture in this age group and mechanism.
• Do Not Miss diagnoses
  • Septic arthritis or osteomyelitis: Although less likely, an infection in the joint or bone could present with similar symptoms and would require prompt diagnosis and treatment to avoid serious complications.
  • Pathological fracture: If the patient has an underlying condition such as cancer, a pathological fracture could occur with minimal trauma. This diagnosis is critical to identify as it would significantly alter management.
• Rare diagnoses
  • Stress fracture: Although more common in younger athletes, stress fractures can occur in elderly patients, especially those with osteoporosis or other underlying conditions affecting bone health.
  • Avascular necrosis of the femoral head: This condition could be a late complication of a hip fracture or dislocation but is less likely as an initial presentation after a fall.