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"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.