EMS brings you a 54 year old who slipped off a wet ladder rung and fell about 15 feet. He is boarded and collared by the paramedics and complains of R hip pain. Vitals are OK, and he complains of pain in his R hip area. “I can stand,” he tells you as you finish your unremarkable primary survey, “but it just hurts . . . a lot”. By exam, he has poorly localizing pain in the R hip and pelvis area, with some pain in the R hip with ROM and axial load. There is no shortening of the R leg, and the N/V exam is normal. You get a quick portable X-ray of the hip, and order the full Monty – total body CT scan – for mechanism of injury

The first portable X-ray is shown (below). What does it show? What else might be helpful?

What does the X-ray show? Answer on next page