Fracture

Diagnosis

•Look : At site, note gross deformities and whether a broken bone has damaged a leg’s blood vessel or nerve.
•Feel : warmth, tenderness, swelling
•Check for muscle strength and sensation in the leg and foot.· Carefully examine the open wound.
For tibial plateau fractures - there is knee effusion.
Tibial tubercle fracture - tenderness over the anterior tibia approximately 3 cm distal to the articular surface. In more severe tibial tubercle fractures, full extension of the knee is not possible. The patella may be high riding.
Tibial eminence fracture - may present with a knee effusion and pain and may represent an avulsion of the tibial attachment of the anterior cruciate ligament.
Tibial shaft fractures - present with localized pain, swelling, and deformity.
Tibial plafond fractures - tenderness along the distal tibial and may have severely decreased range of motion in the ankle.

Investigation

X Ray :
•Fastest and easiest way for a physician to view and assess broken bones and joint and spine injuries.
•Relatively inexpensive and widely available.
•Usually have no side effects in the diagnostic range.
•Risks?
•Slight chance of cancer from excessive exposure to radiation.

CT Scan :

▫For severely injured patients if unable to get diagnostically sufficient radiographs of the knee.
▫For patients with tibial plateau fractures, computed tomography can help further evaluate the extent of the fracture.

Bone Scan :


•The injection.
•Injection of tracers into a vein in the arm. Wait for two and four hours to allow the tracers to circulate and be absorbed by the bones.
•The scan.
•During the scan, the patient should lie still on a table while a machine with an arm-like device supporting the gamma camera passes over the body to record the pattern of tracer absorption by your bones. This is painless. A scan of the entire skeleton takes as long as 60 minutes.

Doppler study : an ultrasound study that uses sound waves to evaluate the blood vessels.
o gives information about the blood flow in the arteries and veins and can diagnose if a blood vessel is open or blocked.
o Procedure : lie on an ultrasound (US) table next to a machine.Gel and a probe is placed on the part of the body to be evaluated.

References :
http://www.dukehealth.org/HealthLibrary/CareGuides/Cancer/TreatmentInstructions/dopplerstudy
http://www.nlm.nih.gov/medlineplus/ency/article/001070.htm
http://members.medscape.com/article/826304-print
http://www.medicinenet.com/fracture/page5.htmhttp://www.radiologyinfo.org/en/info.cfm?pg=bonerad&bhcp=1