Presenting Fractures

[PA2016!]

I am trying to create a template to help me organize my thoughts when presenting a fracture. What do some of the practicing PAs or current students think about this?? I realize it is not an end all be all, but I am just trying to find a good place to start.....

 

 

Pt. presents with an (Open/Closed) (Simple/Comminuted) (Transverse/Oblique/Spiral/Bowing/Buckle/Greenstick) fracture of the (Proximal portoin/Distal portion/Shaft) of the _______________(Insert name of the bone). 

 

The Fx is _____% displaced the width of the shaft in the (Anterior/Posterior & Medial/Lateral) direction.

 

And/Or

 

The distal fragment is angulated _______ degrees relative to the proximal portion.

 

And/Or

 

There is _____cm of (Shortening/Distraction)

 

And/Or

 

There (is/is no) rotation present. 

 

What do you think??? 

[Deanj59]

I'm just about to go on rotations myself, but possibly add something about the neurovascular status that was checked and PROM/ROM present? Great looking outline though!

[UGoLong]

Good point on distal neuro and hemodynamic status. You might also want to add the mechanism of injury.

[winterallsummer]

Sure it is easy.  Pull up the picture of the fracture on a computer and present it while you view the image with your preceptor.  That is the best way!  What we need to know 1) mechanism of injury, 2) what is the neurovascular status 3) if the bone is significantly displaced or not 4) if the fracture is open 5) and what the patient's disposition is.

[Guest JMPA]

Sure it is easy.  Pull up the picture of the fracture on a computer and present it while you view the image with your preceptor.  That is the best way!  What we need to know 1) mechanism of injury, 2) what is the neurovascular status 3) if the bone is significantly displaced or not 4) if the fracture is open 5) and what the patient's disposition is.

and whether or not the patient has insurance

[RealityCheck]

I do not care for templates.

 

With the xray up I would present just as any other.

 

25 yr RHD male s/p punching a wall presents with visibly angulated right 5th metacarpal shaft with intact skin and moderate hematoma/ecchymoses formation. Intact sensory and cap refill to distal finger.

Xrays shows a 40 degree angulated distal 5th Metacarpal fracture without joint surface involvement

 

As 30-40 degrees is the maximal acceptable angulation, I believe this fracture would be most amenable to percutaneous pinning.

 

OR

 

39 yr female presents after tripping on boat dock and rolling her right ankle while intoxicated at a party last night. She heard a snap and has a swollen ankle and cannot bear weight. Skin is intact without wounds and she has full DP and PT pulses. She has medial and lateral tenderness. Achilles intact by Thomas test. She will not actively range the ankle due to pain.

 

Xrays show a lateral malleolus fracture, nondisplaced, transverse below the joint line which would place it as a Weber A1 with no medial malleolus fracture and no widening of the mortise. She is nontender at the fibular head and has intact perineal nerve function.

 

This could be treated conservatively in a boot with WBAT and repeat xray in 10 days to verify stability. Expected healing is 6-8 weeks.

 

You tell the story, you tell the exam, you outline the findings and you have researched the most likely treatment.

 

I worked in the teaching hospital I trained in for the Ortho department and regularly had 25 residents and 12-14 attendings and oodles of students. This was our standard presentation as expected by most of the faculty.

 

Just my thoughts