Langoria’s sign refers to the relaxation of the extensor muscles of the thigh and hip joint in the setting of an intracapsular fracture of the femur. It is elicited by palpating the gluteal and hamstring muscles, which feel unusually soft and spongy on the injured side.

Pathophysiology

• Normal physiology:

  • The extensor muscles of the thigh and hip (gluteus maximus, hamstrings) normally maintain baseline tone.

  • This tone is preserved during palpation, giving the muscles a firm consistency.

• Abnormal physiology (intracapsular femoral fracture):

  • Fracture disrupts the capsular structures and reflex pathways regulating extensor muscle tone.

  • The extensor group on the affected side becomes abnormally relaxed and flaccid, detectable by palpation.

Examination Technique

1. Positioning: Place the patient in a prone position.

2. Palpation: Press firmly on the gluteus maximus and hamstring muscles bilaterally.

3. Comparison: Note greater relaxation and sponginess of the affected side compared with the contralateral side.

4. Documentation: Record side involved, degree of asymmetry, and associated findings (e.g., limb shortening, hip pain, decreased mobility).

Clinical Features

Differential Diagnosis

Special Populations

• Elderly:

  • More common due to osteoporosis and falls.

  • Sign may be subtle in obese patients or masked by pain-related guarding.

• Young adults/athletes:

  • Rare; when present, usually due to high-energy trauma.

  • Clinical correlation with imaging is essential.

Limitations

• Not specific; should be interpreted in context of trauma and clinical findings.

• May be less reliable in patients with muscle wasting, obesity, or pre-existing neuromuscular disease.

• Requires gentle handling, as manipulation may aggravate pain.

Patient Counseling

• Explain that the finding indicates muscle relaxation due to hip joint injury.

• Stress the importance of immediate imaging (X-ray, MRI if equivocal) to confirm fracture.

• Discuss treatment options (surgical fixation or arthroplasty in elderly).

• Warn against walking or weight-bearing until definitive diagnosis is established.

Conclusion

Langoria’s sign is a classical bedside indicator of an intracapsular femoral neck fracture, demonstrated by relaxation of the thigh and hip extensor muscles on the affected side. While helpful, it is not pathognomonic and must be interpreted alongside history, examination, and imaging to guide appropriate management.

References

1. Adams JC, Hamblen DL. Outline of Orthopaedics. 15th ed. Edinburgh: Churchill Livingstone; 2010.

2. Rockwood CA, Green DP, Bucholz RW, Heckman JD. Rockwood and Green’s Fractures in Adults. 9th ed. Philadelphia, PA: Wolters Kluwer; 2020.

3. Solomon L, Warwick D, Nayagam S. Apley’s System of Orthopaedics and Fractures. 10th ed. Boca Raton, FL: CRC Press; 2018.

4. Singh M, Nagrath AR, Maini PS. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg Am. 1970;52(3):457–467.