Oblique views are also helpful for detecting subtle spiral fractures where the AP and lateral views are normal, yet a fracture is strongly suspected.Īnkle AP mortise view is helpful since it includes distal tibia, distal fibula, talus, and proximal metatarsals. Oblique views are helpful for fully disclosing the nature and extent of many fracture patterns, especially when the injury involves the ankle, elbow, hand (especially for scaphoid fracture), or foot. It isvaluable to obtain comparison views of the contralateral side, especially if there is suspected physeal injuries which may have very subtle radiographic abnormalities.Īnteroposterior (AP) and lateral views are the most common. Radiographs should include the joints immediately proximal and distal to a fractured long bone. X-Rays: At minimum, two views are obtained, taken at 90-degree angles.Evidence of neurovascular compromise necessitates urgent, often operative, orthopedic treatment. Assessment of two-point discrimination is probably the best test of sensory function. Check the integrity of pulses and speed of capillary refill, as well as testing sensory and motor function. Checking neurovascular function distal to the injury is essential in evaluating any child with a potential fracture.Pain on motion and limitation of motion signal the need for further examination. Observe the spontaneous movement, attempts to get the patient to voluntarily move the involved part through its expected range, and passive movement. Palpation and assessment of active and passive motion: localized swelling and tenderness on palpation are significant findings and should alert the examiner to the likelihood of an underlying fracture.Comparison with the opposite extremity and measurement of circumference can be very helpful when findings are subtle. Evaluate the overlying skin and soft tissues for swelling, ecchymosis, abrasions, punctures, and lacerations. Visual inspection: Gross position of the extremity allows you to appreciate for presence or absence of deformity, distortion or abnormal angulation, and longitudinal shortening.
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