Since we're on to toes, inability to flex is THE important abnormality that
must prompt an x-ray as it invariably implies dislocation of an IP joint. So
your comment that "there was no definite abnormality except the toe could
not flex properly" is kind of self-contradictory. We could start a new
thread on toe injuries, but on the other hand, that's all one really needs
to know about them!!
Adrian Fogarty
A&E Consultant
Royal Free Hospital
----- Original Message -----
From: Doc Holiday <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, September 01, 2000 2:55 AM
Subject: Re: Necks in A&E
> ...and your argument is appreciated as well, but I did not mean to imply I
> X-ray all "minor" mechanism injuries, merely that I do not ignore a
possible
> pathology merely on the basis of certain historical details. Litigation
> plays no part in my decisions as I have no experience, but I did bring the
> statistics in because they made sense.
>
> I don't X-ray most sore toes. The vast majority, as most of you expect, I
> manage "clinically". But that's mainly because, in my training, X-rays do
> not play a role usually in their management, while in C-spine suspected
> injury they do. How minor is minor is a question I also have no time for.
>
> I am sure it might have happened to you, as it has to me, that a patient
> came back with a "sore toe" for a second A&E visit. In my case I saw a
> patient 6 weeks after a colleague at another hospital managed his
> minor-mechanism stubbed 2nd toe with Clinical exam, neighbour-strapping
and
> the usual. I did the same exam and found NO definite abnormality, except
the
> to could not flex properly. So I sent him for an X-ray. Then I had to
> re-iterate my ordr to the radiographer, whom I commend for inquiring
before
> doing what is, as you explain, an unusual X-ray.
>
> Of course, the tow was dislocated at the pipjt. It was OK after an open
> reduction. I know, becuase the patient is also a colleague of mine and I
> also know there will be no litigation.
>
> But I do not want someone finding a similar situation with a C-spine I
> decide not to X-ray.
>
> I will limit myself to one anecdote and therefore no comment on
antibiotics
> for sore throats...
>
> But I do have one... If you really want it.
>
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