Question

Musculo-Skeletal Disorders (MSD). In the Emergency Department you have received a patient with a suspected leg fracture. What are the Signs & Symptoms of a fracture that you would look for to confirm such a diagnosis?

Answer 1

An inability to bear weight on the affected leg and a visible malformation of the leg are often present. Partial fractures may be less characteristic in presentation. The evaluating physician should always keep tibial fracture as part of the differential diagnosis after trauma, especially in a patient with an altered mental status who cannot provide a reliable history.

If the patient's symptoms stem from a stress fracture, the patient may report a recent change in lifestyle or an increase in physical activity. The pain is worse with weightbearing exercise and improves with rest. A classic presentation is an athlete who did not participate in conditioning work during summer vacation and presents to the physician's office 2 weeks after beginning vigorous training in a fall sport.

Whatever the presentation, a complete history and a thorough physical examination are important. The history should include the patient's description of the events that brought him or her to the office. Important details to obtain from the patient include the following:

• Exactly what the patient was doing at the time of the injury

• The amount of time that has passed since the injury occurred

• Nature and severity of pain

• Any associated paresthesias or numbness

• Any previous conditions that predispose to this injury or complicate surgery