A patient with hip fracture is suspected after an elderly fall. Which fracture best fits a shortened leg with external rotation?

• A. Femoral neck fracture
• B. Acetabular fracture
• C. Tibial plateau fracture
• D. Calcaneus fracture

Answer: (A)

When a patient falls and you suspect a hip injury, a leg that is shortened and externally rotated is a classic clue that points to a displaced proximal femur fracture, most commonly a femoral neck fracture. The hip region breaks in a way that the femoral head and neck lose their normal alignment within the socket, and the intact external rotator muscles pull the leg outward. That outward pull combined with loss of length makes the limb appear shortened.

This presentation helps distinguish it from other injuries. A tibial plateau fracture involves the knee joint and presents with knee pain, swelling, and difficulty bearing weight rather than a globally shortened leg. A calcaneus fracture affects the heel and foot, causing heel pain and inability to stand on the heel rather than a shortened limb. An acetabular fracture involves the socket of the hip and can cause hip instability or pain, but the hallmark shortened, externally rotated limb is most characteristic of a femoral neck fracture.