An elderly patient fell and presents with her left foot rotated laterally. You should suspect

• A. Fracture
• B. Dislocated ankle
• C. Sprain
• D. Dislocated hip

Answer: (D)

When a patient who fell has the entire leg lying in an externally rotated position, this points to disruption at the hip joint rather than the foot or ankle. A dislocated hip means the femoral head has come out of the acetabulum, which alters the alignment of the whole limb and often causes significant pain and inability to move the hip. This makes hip dislocation the most concerning and likely diagnosis in this scenario, and it is an emergency that requires prompt imaging of the pelvis and hip and urgent orthopedic management for reduction.

In contrast, a sprain or ankle/foot injury would produce pain localized to the ankle or foot with less dramatic global leg deformity, and a simple fracture of the foot wouldn’t explain the leg’s outward rotation in the same way a hip joint disruption does. Hip fractures can also cause external rotation, but the obvious, abnormal alignment and the high concern for joint disruption after a fall in an elderly patient make a hip dislocation the best fit for this presentation.