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Imaging is only part of the picture!


Being sent for an x-ray by your Doctor or Physiotherapist is not unusual especially if you can not take weight on a limb. However, Foundation Physiotherapists don’t diagnose an injury based solely on the x-ray and for very good reason.

Beryl came to Foundation 3 weeks after a fall.  She was clearly in a lot of pain in her back and leg.  Her doctor had already sent her for x-rays of her back, hips and knee and all of these had come back clear of any new broken bones.  She was found to have a “wedge fracture” in her back which is something that can happen with age but can also result from underlying bone weakening or Osteoporosis.  Beryl’s symptoms were attributed to her “wedge fracture” and plans were made for her to have a Bone scan and continue Physiotherapy.

Over time Beryl reported improvements in pain however she continued to have trouble walking.  The Physiotherapist looking after Beryl, knew that something wasn’t right so asked a Senior colleague to review her. 

A thorough assessment of Beryl was performed including a detailed timeline of events from trauma to the present day.  After this a thorough physical examination was performed.  It was clear that Beryl’s back pain and movement had improved from her initial appointment and it was possible to perform more tests but movement of her hip was extremely limited and painful.  Clinically she had all the symptoms of a broken hip but the x-rays said this wasn’t the case.  Or did they?

We took the time to review the x-rays in depth with Beryl and with an understanding of Beryl’s current pain we looked very closely at the hip joint.  The outline of the hip didn’t look as it should but the angle of the picture was slightly rotated so with the current assessment findings, we called the local radiologist to ask if they could review the images.  It was recommended that we sent Beryl for some more x-rays and sure enough they came back confirming that Beryl had broken her hip.  We sent Beryl off to Hospital with a transfer letter, contacted her GP with an update on her care and made sure she was followed up, long after she left the clinic.

In Hospital, the decision was made not to operate on Beryl’s hip because it was now 6 weeks after her original injury.  Beryl was kept in hospital for a few days, sent home walking on crutches and recently came back to Physiotherapy with a request from her Orthopaedic specialist to help her with her continued recovery.

So, what do we learn from this? 

Well, firstly Beryl is recovering well and continues to with her rehabilitation.

Secondly, some important facts regarding fracture, osteoporosis, falls and preventative measures:


  • Osteoporosis or weakened bones is a risk factor for fractures from minimal trauma in people aged 50, particularly women. 
  • Fewer than 1 in 10 patients in New Zealand, are on active treatment for Osteoporosis on admission to hospital with hip fractures. 


  • Diet is important for bone health.  Make sure your diet has enough Calcium and you get outside to benefit your Vitamin D levels from the abundance of sunshine the Bay has to offer.
  • Weight bearing exercise and strength training are vital to keeping your bones and muscles strong.  Strength training also reduces the risk of falls.
  • Falls prevention programs.  If you have fallen and have become less steady on your feet, seek advice from experts to help you get stronger and reduce the risk of falls.
  • Know your bone health - Take the IOF 1 minute test on the Osteoporosis New Zealand website to see if you are at increased risk & discuss the results with your GP to see if your need a DEXA scan.
  • For more information visit www.osteoporosis.org.nz

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