By Guest on Sunday, 08 October 2006
Posted in Match Center
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Fracture description is a difficult skill to learn without much experience. Basically there is a list of things you rattle off. Some med students make the mistake of going through the normal anatomy, or walking up and pointing all over the xray as they talk... Here is my advice:

First learn the different types of fracture descriptive terms. Ie. spiral, transverse, oblique, angulation, rotation, translations, etc. The best source for this for med students is probably (that I have seen) "Essentials of Orthopaedic Surgery" by Wiesel and Delahay. Go to page 47 at the begining of the chapter on Skeletal Trauma and read the first several pages. This book is a great read for med students anyway and I highly reccomend it.

Now comes the proformance, when asked to describe an Xray, walk up, look carely at the Xray for a few seconds and take all the info you can in. Then turn to the group and describe Without Pointing, or Waving your hands.

Your presentation should include the following...

-- This is a [name the radiograph (AP, Lateral, Oblique, Cross table lateral, etc)]
-- of the [name the body part (right femur)].
-- There is an [intra vs exrtaarticular (if it is near the joint)],
-- [describe displacement (angulated -describe apex-, proximally dispaced -- describe distal segment-, rotated, distracted, translated, etc]
-- [describe the fracture type (oblique, transverse, spiral, etc) DO NOT USE NAMES at this point, wait until the end of the presentation]
-- of the [describe the location (proximal 1/3, mid shaft, distal 1/3,
metaphaseal/diaphaseal junction, tibial pleateau etc)]
-- with [describe comminution (minimal comminution, moderate comminution, etc.)].
-- It is a [Say Name or classification here]

It is impressive when it can all be done in one or two sentences (practice in your head on xrays that you are not asked to describe)

Here is an example...

"This is an AP and Lateral of the right leg. There is an shortened, apex valgus angulated, transverse fracture of the mid shaft of the right tibia with a distracted, spiral fracture of the proximal fibula. There is minimal comminution. "

-adaman
"This is an AP and Lateral of the right leg. There is an shortened, apex valgus angulated, transverse fracture of the mid shaft of the right tibia with a distracted, spiral fracture of the proximal fibula. There is minimal comminution. "

-adaman


I will say it a little bit different

mid tibia transverse fracture plus spiral proximal fibula with shortening, valgus angulation and minimal fragmentation

more simple and concentrated on clinicaly significant findings (mention first)..residents are same kind of people as you are.... they like simplicity and short discriptions
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19 years ago
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also in your opening sentence it should mention whether the patient is skeletally mature or not.
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19 years ago
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adaman brings up a great point for ortho in general-- when presenting anything to a resident or attending, you should be able to describe everything with words. it is so tempting to hold out your hand and say "he has a 1cm cut from here to here," rather than "there is a one centimeter longitudinal laceration on the volar aspect of the middle finger extending from the PIP to DIP joint." know what i mean?

and with regard to fracture description above, y'all have described two different fractures. in the first, the tibia has an apex valgus angulation, in the second, based on syntax, the fibula is angulated.

cheers.
fg
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19 years ago
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Actually, interestingly, we all used to say "skeletally mature" in our descriptions at Hamot, but then in our weekly peds conference, the top Peds attending suggested that we not metion it at all. Rather, describe the fracture only in terms of its relation to the physis if the physis is involved. So now we omit it.

-Adaman
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19 years ago
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