Case report: Not so hip

The winter is slowly winding down—and hopefully the number of seasonal patient problems will diminish. Cold air, ski and skate injuries and the frequent low back strains from snow shovelling have all been factors in the past few months. Although we have almost reached April, the environment still poses risks.A 54-year-old, hefty, fair-skinned man came to our walk-in clinic recently, following a slip and fall on icy cement stairs a week earlier. He was healthy, with no underlying illness, taking no medications (notably no aspirin) and had no allergies. The day after his fall on his right “hip,” he was seen at hospital emergency because of an alarming painful rash (see picture) which had appeared overnight. As usual, he was x-rayed—reportedly negative—and given no treatment. When the tender rash persisted, he came to our clinic for a reassessment.Examination revealed the large, evolving bruise on his right lower back—well above the x-rayed hip. It was apparent that his original hip concerns, which undoubtedly led to the X-ray, were unfounded. The contusion was to soft tissues, with no bony involvement. The area was tender to palpation, but very superficial. I prescribed Naprosyn (and Tecta to protect his stomach), and discussed the fact that the bruise would be slow to resolve- and may assume other interesting colours in the process. Follow-up with his family doctor was advised if he did not gradually improve.The patient’s concerns included fear of a dreaded “hip” injury and ongoing rash (not given much time or advice from hospital) and pain. It is prudent to remember that there is always some seasonal environment to consider—with warmer weather waiting to inflict gardening injuries and sunburn.

Case report: Not so hip

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