Fracture (cont.)
How is a fracture diagnosed?
When you arrive for medical care, the doctor will take a history of the
injury. Where, when, and why did the injury occur? Did the person trip
and fall, or did they pass out before the fall? Are there other injuries that
take precedence over the fracture? For example, a person who falls and hurts
their wrist because they had a stroke or heart attack will have their fracture
care delayed to allow care for the life threatening illness. The injured area
will be examined and a search will happen for potential associated injuries.
These include damage to skin, arteries and nerves.
Pain control is a priority and many times, pain medication will be prescribed
before the diagnosis is made. If the doctor believes that an operation is
likely, pain medication will be given through an intravenous (IV) line or by an
injection into the muscle. This allows the stomach to remain empty for potential
anesthesia.
A decision will be made whether x-rays are required, and which type of x-ray
should be taken to make the diagnosis and better assess the injury. There are
guidelines in place to help doctors decide if an x-ray is necessary. Some
include the Ottawa ankle and knee x-ray rules.
The body is three dimensional, and plain film x-rays are only two
dimensional. Therefore, two or three
x-rays of the injured areas may be taken in different positions and planes to
give a true picture of the injury. Sometimes the fracture will not be seen in
one position, but is easily seen in another.
There are areas of the body where one bone fracture is associated with
another fracture at a more distant part. For example, the bones of the forearm
make a circle and it is difficult to break just one bone in that circle. Think
of trying to break a pretzel in just one place, it is difficult to do. Therefore broken bones at the
wrist may be associated with an elbow injury. Similarly, an ankle injury can be
accompanied by a knee fracture. The doctor may x-ray areas of the body that
don't initially appear to be injured.
Occasionally, the broken bone isn't easily seen, but there may be other signs
that a fracture exists. In elbow injuries, fluid seen in the joint on x-ray is
an indicator of a subtle fracture. And in wrist injuries, fractures of the
scaphoid or navicular bone may not show up on x-ray for one to two weeks, and
diagnosis is made solely on physical examination with swelling and tenderness
over the snuffbox at the base of the thumb.
In children, bones may have numerous growth plates that can cause confusion
when reading an x-ray. Sometimes, the doctor will choose to x-ray the opposite
arm or leg to determine what normal is for the child before deciding whether a
fracture exists.
Next: What is the treatment for a fracture? »
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