Step 2: Perform an Examination

Objective :

Recognize someone with a fractured hip, and the need for a systemic examination in this scenario
Tip 1
Right groin

Look:The right leg is shortened and externally rotated.

Feel: Palpation over the groin is very tender.

Move: Any attempt at moving the limb produces marked pain.

Special tests: Neurovascular examination is normal.

Tip 1

Look: Normal appearance, no skin puckering or nipple discharge.

Feel: Careful examination reveals a firm, craggy 2 cm lump in the left breast.

Lymphatics: You do not palpate any nodes in the axilla.

Tip 1

Look: Thyroid not enlarged, no apparent mass noted.

Feel: No goiter, but one enlarged supraclavicular lymph node.

Tip 1
Chest and Abdomen

Chest: Her lungs sound clear on examination.

Abdomen: Is soft, with no masses or organomegaly.

More Info Next Step

The most likely diagnosis is a pathologic fracture. The presence of a breast mass is suspicious for neoplasia, and the fact that there is an enlarged lymph node is suspicious for metastatic disease. The deformity and pain in the right hip is typical of a femoral neck fracture.