She limped into the office assisted by a cane. She said that she did not believe the bone was broken, but had experienced hip misalignment after falling several times in the past. I conducted a quick examination and, taking her at her word, decided to put off having her x-rayed immediately. The orthopedic hip tests were all positive, so I performed only some gentle adjustment and soft tissue work to align the hip, and asked the patient to come back early Monday morning.
On Monday the patient reported that she was feeling much better. I carried out a careful examination, and then told her that although she was walking and completely weightbearing, there was a possibility that the hip had been fractured by the fall and recommended an x-ray. She agreed and I referred her to a radiologist.
After the x-rays were taken, the radiologist found a fracture of the left femoral neck and, per my request, arranged to have the patient be seen immediately by an orthopedic surgeon at a hospital.
The patient called to thank me for recommending the x-ray and for my chiropractic care. She said the surgeon told her that it "should be an easy operation because of the perfect alignment of your hip bones." It seems that the gentle adjustment I had done not only relieved her pain, but also brought her hip bones into alignment.
In retrospect, the patient should have been referred for an x-ray in the initial examination, but it was late Saturday (not the most convenient time to arrange for an x-ray) and the patient was mobile and not in great pain. The decision to recommend x-ray following the second examination proved to be the right course of action. The lesson in all this is to follow the standards of care and protocols and x-ray now.
June Leslie Wieder, DC
New York, New York