fracture (easy to miss in general practice)

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The following are fractures until proved otherwise:

  • impacted hip fractures - pain or walking difficulty after a fall in an elderly person
  • impacted fracture of humerus or distal radius - the degree of pain may be the only clue
  • greenstick fracture of forearm - degree of pain or typical site of pain especially in a child
  • wrist pain may be a scaphoid fracture (common cause of litigation against doctors because of the degree of permanent disability) - record whether there is scaphoid tenderness at the anatomical snuffbox - treat the tenderness as a fracture despite a normal Xray report
  • fractures of the lateral malleolus can be misdiagnosed as a sprain if swelling is extensive - if in doubt, refer
  • injuries in paralysed or unconscious patients or who have neuropathy, eg diabetes or MS, are very easy to miss
  • rib fractures occur twice as often as appear on Xrays. Treatment is usually unaffected.

Last reviewed 01/2018

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