Week 1: Lab Bone Assessment

signs of fracture

deformity of bone, edema, bruising, loss of general function or mobility

symptoms of fracture

pain, point tenderness over fracture site, increase symptoms with vibration or tapping

gently tapping over suspected area causes

increase of symptoms (positive test for fracture)

closed fist percussion test

seated slightly bent over, apply force through fist on metacarpal joints

positive test: local pain

fracture without neurological compromise

positive test: radicular pain

fracture disc defect with neurological compromise

positive test: pain in paraspinal muscles

muscle strain

tuning fork

acceptable if no imaging, easy and painless, not used alone for detection

using a tuning fork

placed on bone distally to assumed fracture, place stethescope proximal, listen for 6-8 sections

uninjured bone sound

clear tone

fractured bone sound

diminished or absent sound

Ottawa ankle rules

x ray is required only if there is pain in any of the following areas

-tender at posterior edge of lateral or medial malleolus

-inability to WB

Ottawa rules for foot trauma

xray is required if there is pain in midfoot if:

-tender at base of 5th metatarsal, navicular

-inability to WB

Bernese ankle rules

augment the ottawa ankle rules, not as sensitive though

bernses ankle rules 3 assessments

1) indirect fibular test

2)direct medial malleolar stress

3)compression stress on mid and hind foot

indirect fibular stress maneuver

one hand on medial leg 10 cm proximal to fibular tip, other hand on lateral leg 10cm proximal to fibular tip

-compress

-avoid direct palpation of distal fibula

direct stress on medial malleolus

pres thumb flat against medial malleolus

compression stress on the mid and hind foot

calcaneus in neutral with one hand, forefoot with other hand (palm to sole), push together to generate compressive force

if any of these tests cause pain, then

acute fracture is suspected

if indirect test is positive but radiograph is negative, then

Ct scan should be considered

Ottawa knee rules

require xray if

-over 55

-tenderness only at patella

-tender at head of fibula

-cant flex to 90

-cant WB

pittsburgh knee rules

if under 12 or over 50, or have instability to walk 4 WB steps they get an knee xray

Canadian c spine rule

-high risk factor that mandates radiography

-over 65

-dangerous mechanism

-paresthesias in extremities

whats considered a dangerous mechanism

fall over 3 feet, axial load to head, MCV high speed, motorized vehicles

c spine rule is not applicable if

non trauma cases, GCS under 15, unstable vitals, age under 16, acute paralysis, known vertebral disease, previous c spine surgery