TABLE 2591 Mechanisms Associated with Particular Orthopedic Injuries

Some musculoskeletal injuries or conditions may not necessarily be associated with a history of trauma. Occult fracture of the hip in an osteoporotic individual, occult stress fracture of a metatarsal in someone who has recently done an unusual amount of walking, and slipped capital femoral epiphysis in a preteenager or young adolescent, are all examples of injuries whose symptoms may be gradual and insidious in onset, unrelated to an isolated traumatic event. Tenderness to palpation or pain on weight-bearing or range-of-motion suggests the possibility of an occult or easily missed fracture. Depending on the index of suspicion, further studies, such as bone scan or magnetic resonance imaging (MRI), may be indicated to rule out significant pathologic conditions before the patient is allowed to resume weight-bearing.

History taking should not necessarily be limited to orthopedic issues. Depending on the situation, a general medical history should be obtained, since it may have implications for further workup, the potential for complications, or ultimate prognosis for recovery of function. For example, relevant items may include a history of heart disease, anticoagulant medication, falling due to syncope or transient hemiparesis rather than simply stumbling, or an unsteady baseline gait that cannot withstand further impairment.

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