Hip iSAWE 17

Question

An 86 year old woman with bilateral hip replacements falls from standing. She cannot mobilise because of groin pain.

Hip iSAWE 17, AP radiograph of the pelvis
AP radiograph of the pelvis. Image by James Heilman, MD, Wikimedia Commons, CC BY-SA 4.0.
  1. Describe the radiograph.
  2. How would you investigate further?
  3. Outline management.

Answer

Radiograph

  • Fractures of the right superior and inferior pubic rami
  • Bilateral total hip arthroplasties
  • Fragility fracture of the pelvis

Further investigation

  • CT in most, posterior ring injury coexists in up to 80%
  • Rommens and Hofmann FFP classification guides treatment
  • Bone health assessment and falls review

FFP classification

TypeDescription
IAnterior ring only
IINon displaced posterior injury
IIIDisplaced unilateral posterior injury
IVDisplaced bilateral posterior injury

Management

  • Analgesia, early mobilisation and physiotherapy
  • Orthogeriatric care and delirium prevention
  • Osteoporosis treatment
  • Fixation (iliosacral screws or anterior ring fixation) when pain stops mobilisation after a week, or for FFP III and IV
  • One year mortality is similar to hip fracture
  • Many lose independence

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.