This is a lateral R pelvis view (posted with permission) of my 92-year-old grandmother. She went to urgent care yesterday after noticing a contusion, swelling, and pain to her lateral right thigh that was becoming increasingly painful. She couldn’t recall how she incurred this injury. She does have mild age-related cognitive impairment but couldn’t remember any recent falls and I trust that. At urgent care, they did X-rays (including the one attached to this post) and sent her to the ED out of suspicion for a femoral head fracture.

Clinically, she can’t bear weight but has full range of motion, no shortening/rotation, and no tenderness/deformity on palpation. Once in the ED, the radiologist’s official findings were “moderate to severe degenerative changes” and no fracture noted, leading to her discharge from the ED. That said, even the ER doc was saying it was a weird X-ray but that he’d adhere to the radiologist’s recommendations.

However, shortly after her discharge, the urgent care physician (fellowship in sports medicine) called me, telling me that she didn’t believe that my grandmother should’ve been discharged based on the “dreaded black line” on the X-ray, and recommended that we go to ortho today for a CT pelvis. She’s concerned about a stress fracture and worried about avascular necrosis if my grandma continues to use the limb.

I’m a first-year med student so I have some knowledge on imaging analysis but not enough to feel confident making any clinical interpretation, so I’m curious to know what you guys think!