What is the most likely diagnosis for an elderly man with hip pain, external rotation, and inability to bear weight?

• A. Trochanteric bursitis
• B. Posterior hip dislocation
• C. Slipped capital femoral epiphysis
• D. Intertrochanteric fracture

Answer: (D)

In elderly patients, hip pain accompanied by symptoms such as external rotation and inability to bear weight often indicates a significant injury, particularly involving a fracture. An intertrochanteric fracture, which occurs in the region between the greater and lesser trochanters of the femur, is a common injury in older individuals, frequently resulting from low-energy falls.

The presentation of external rotation in conjunction with hip pain is characteristic of this type of fracture. When an intertrochanteric fracture occurs, the affected leg tends to adopt an externally rotated position due to muscle contractions around the hip, such as those from the iliopsoas and gluteal muscles, which are not countered by the fractured femur's stability. The patient's inability to bear weight further supports the diagnosis, as fractures typically result in significant pain and instability in the affected area.

In contrast, other conditions mentioned, while they could potentially present with similar symptoms, are less likely in this demographic or show different clinical features. For example, trochanteric bursitis usually does not cause significant inability to bear weight, and the pain is more localized rather than presenting with the level of dysfunction seen in fractures. A posterior hip dislocation might present with leg positioning and internal rotation instead, while