MANUAL MINORS
Traumatic hip pain without evidence of fracture refers to the presence of pain in the hip region following trauma, where initial X-rays show no obvious fractures. This scenario may arise from soft tissue injuries, microfractures not visible on standard imaging, or conditions such as muscle contusions, ligament injuries, or even subclinical dislocations.
Diagnosis
Diagnosis begins with a detailed medical history to identify the mechanism of injury and associated symptoms. A thorough physical examination is required to assess mobility, stability, and the presence of tender points or swelling.
Initial X-rays may not reveal fractures, but if clinical suspicion persists, further studies such as computed tomography (CT) or magnetic resonance imaging (MRI) may be necessary, especially to rule out occult fractures or intra-articular injuries.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Muscle or tendon injuries | Pain on palpation or active movement, with no findings on X-rays |
Bone contusion | Localised pain with oedema on MRI |
Occult fracture | Persistent pain, sometimes without findings on X-ray, visible on CT or MRI |
Acetabular labrum injury | Pain during hip flexion and internal rotation; best evaluated with MRI |
Subclinical hip dislocation | Instability without obvious displacement on standard imaging |
Early avascular necrosis | Progressive pain, visible in early stages only on MRI |
Emergency Management
Initial management in the emergency department includes relative immobilisation, pain relief (non-opioid analgesics or NSAIDs), and rest of the affected joint. If severe injuries such as occult fractures or labral tears are suspected, immobilisation is recommended until advanced imaging is performed. Non-weight-bearing on the affected limb may be necessary until more serious injuries are ruled out.
Definitive Treatment
Definitive treatment depends on the final diagnosis. Soft tissue injuries such as contusions or muscle strains are managed with physiotherapy, NSAIDs, and pain management. For more complex injuries such as occult fractures or intra-articular damage, treatment may include surgery, prolonged rehabilitation, and periodic re-evaluation with imaging.
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