What are the key clinical features to consider when diagnosing a hip fracture in an older adult?

Key clinical features to consider when diagnosing a hip fracture in an older adult include:

• History of a recent fall or trauma, often from a low-energy mechanism such as a fall from standing height, which is common in older adults with fragility fractures NICE CKS.
• Acute onset of hip or groin pain, which may be severe and exacerbated by movement NICE CKS.
• Inability or marked difficulty in weight-bearing or walking on the affected leg NICE CKS.
• Physical examination findings such as shortening and external rotation of the affected leg, swelling, bruising, and tenderness over the hip region NICE CKS.
• Assessment of pain severity and response to analgesia is important, as pain may limit examination and mobility NICE CG124.
• Consideration of risk factors for fragility fractures such as advanced age, osteoporosis, previous fragility fractures, corticosteroid use, and comorbidities that increase fall risk NICE CKS.
• Exclusion of other causes of hip pain such as rapidly progressive hip osteoarthritis, metastatic bone disease, or other bone pathologies, which may present with bone pain but have different clinical features like systemic symptoms or gradual onset Oprișan et al. 2024 NICE CKS.
• Imaging is essential for diagnosis; initial hip X-rays are standard, but if negative and suspicion remains high, MRI is recommended to detect occult fractures NICE CG124.

Overall, the diagnosis relies on a combination of clinical history, physical examination, risk factor assessment, and appropriate imaging to confirm the presence of a hip fracture in older adults NICE CKS,NICE CG124.