What is the typical leg position in a hip fracture?

• A. Shortened and externally rotated.
• B. Lengthened and internally rotated.
• C. Neutral position with no rotation.
• D. Shortened and externally rotated.

Answer: (D)

Hip fractures typically present with a shortened leg that is externally rotated. This happens because the broken femoral neck or intertrochanteric region allows the proximal fragment to settle and overlap with the distal part, producing shortening. Meanwhile, the muscles that externally rotate the hip (such as the piriformis and other short external rotators) act unopposed, pulling the leg into external rotation. Internal rotators are less effective in the setting of fracture, so the rotation tends to be outward rather than inward. This combination—shortening plus external rotation—is a classic hallmark of hip fracture and helps distinguish it from other hip injuries or knee issues. Lengthening with internal rotation or a neutral position without rotation would not fit the typical injury pattern, and neutral with no rotation would be unusual given the usual muscle and fragment dynamics.