An elderly woman has fallen and is in pain. The leg appears externally rotated. Which fracture is most likely?

• A. Femur
• B. Tibial-fibular
• C. None of the above
• D. Hip

Answer: (D)

External rotation of the leg after a fall in an elderly person is a classic sign of a hip fracture. When the proximal femur (the hip area) is broken, the surrounding muscles pull the leg outward and the limb often shortens, so the foot ends up rotated externally. Osteoporosis makes this injury common after low-energy falls in older adults, which is why hip fracture is the most likely scenario here.

Fractures of the tibia/fibula or a femur shaft tend to cause visible deformity or swelling along the leg and pronounced pain along the bone itself, rather than the characteristic outward rotation of the entire limb seen with a hip fracture.