Differential Diagnosis for 75-year-old Female with Hip Discomfort after Fall
- Single most likely diagnosis:
- Contusion or soft tissue injury: Given the mechanism of injury (fall onto the side) and the delayed onset of discomfort, a contusion or soft tissue injury to the right posterior hip is the most likely diagnosis. The fact that she hit her head but denies loss of consciousness and the hip X-ray is negative also supports this diagnosis.
- Other Likely diagnoses:
- Muscle strain: The patient's description of an aching soreness to the side/back of her hip could be consistent with a muscle strain, particularly given the mechanism of injury.
- Bursitis: Inflammation of the bursae around the hip joint could cause the type of discomfort the patient is describing, especially if the fall irritated the bursae.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Hip fracture (non-displaced): Although the X-ray was negative, it's crucial not to miss a non-displaced hip fracture, which could be devastating if not promptly treated. Further imaging like an MRI might be necessary if suspicion remains high.
- Abdominal or pelvic injury: Given the mechanism of injury and the fact that she fell onto her side, there's a possibility of internal injuries that might not be immediately apparent.
- Head injury (subdural hematoma): Although she denies loss of consciousness and the primary complaint is hip discomfort, the fact that she hit her head on the grass warrants consideration of a potential head injury, especially in an elderly patient where the risk of subdural hematoma is higher.
- Rare diagnoses:
- Osteonecrosis: Although less likely, osteonecrosis of the femoral head could be a consideration, especially if the patient has risk factors such as long-term steroid use or excessive alcohol consumption.
- Pathological fracture: If the patient has an underlying condition like osteoporosis or a bone tumor, a pathological fracture could be a rare but possible diagnosis.