"Scott, Charles" <[log in to unmask]>typed
> We have just had a case where a 25 year old woman was hit on the forearm
> and she sustained a "defensive" injury of the distal ulna. She had
> local tenderness on the distal ulna only with no other bony tenderness.
> Xray was normal, so she was discharged. 3 days later she attends St
> Elsewhere's because the arm is still very sore and they find this.
> Even with hindsight the original film is normal. We know these things
> happen but what is the scientific reason the fracture doesn't show on
> the original film taken on the day of injury?
I am no expert, but I don't understand how a fracture *can* show if
there has been absolutely no movement or resorption in compact bone. A
sclerotic line can be visible in trabecular bone
> And how often should we
> re-xray patients who complain that the limb still hurts? We are
> familiar with the scaphoid scenario but should this apply to all
> fractures? I think not as this is a rare occurrence, but still going to
> cause us trouble via the complaints procedure.
Indeed.
Re X-ray at 3 days is reasonable if still symptomatic and this happened
even though you hadn't arranged it.
I doubt that any harm will have occurred.
Perhaps we should issue patients who have negative X-rays with leaflets
explaining that not all fractures show on initial views and that they
should seek advice after a few days if still symptomatic.
> The exception is I
> think patients who return with pain in the hip; we always re-xray hips
> as fractures are well known to show late.
Very wise IMO.
> Is it that the ulna injury
> is a variety of stress fracture which are notorious as only showing on
> X-ray after a few weeks, but why should a single blow to the forearm be
> a stress injury?
This is not a stress injury IMO.
Truly undisplaced (rather than minimally displaced) fractures can be
invisible.
Would you see a crack in your cereal bowl before it got stained with tea? ;-)
--
Helen D. Vecht: [log in to unmask]
Edgware.
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