This document outlines the need for and considerations in clinical examination of bone injuries. It discusses examining the patient's age, mechanism of injury, and presenting complaints like pain, swelling, deformity and loss of function. The examination involves proper exposure, comparison to the uninjured side, and checking for swelling, deformity, tenderness, bony irregularity, abnormal mobility, and transmitted movement. It also addresses determining if the injury is an open fracture or pathological fracture. The goal is to decide if imaging is needed, need for special views, detect complications, and avoid making wrong decisions by correlating clinical and radiological findings.

2. NEED FOR CLINICAL EXAMINATION:
To decide if X-ray is needed
To decide for a special view
(oblique view for scaphoid #)
To detect complications
(injury to neurovascular bundles)
To avoid making wrong decisions
(by correlating the clinical findings & radiological
findings)

3. CONSIDERATIONS IN CLINICAL EXAMINTAION:
1. AGE
2. MECHANISM OF INJURY
3. PRESENTING COMPLAINTS
Pain
Swelling
Deformity
Loss of function

4. 1. AGE OF PATIENT:
Fracture occur at all ages but dislocation are
uncommon in children.
Fracture common in particluar age groups

5. 2. MECHANISM OF INJURY
• Mechanism by which the patient sustains the
injury often given an idea about the expected
fracture/dislocation.

6. 3. PRESENTING COMPLAINTS:
• Pain:
 Commonest presenting complaints
 Severity has no bearing on the diagnosis
 Sprains and strains can be as painful as
fracture
• Swelling:
 Patient presents early – less swelling
 Patients presents late – more swelling
(mostly because of gravitational oedema)

7. • Deformity:
 Fractured bone may result in deformity of
that part of the body.
• Loss of function:
 Following fracture, the patient may be unable
to use the affected limb.
3. PRESENTING COMPLAINTS:

8. EXAMINATION:
 Proper exposure of the part to be examined
 Comparison between injured and normal
extremity
 Joint proximal and distal to injured bone
should be examined

9. EXAMINATION:
• Swelling:
Mostly accompanied with cases of fracture
Can be misleading sometimes-
Minimal swelling visible in cases of serious #
Eg- fracture of neck of femur
Massive swelling in absence of #
Eg- swelling due to hematoma, prominence of
bones end

10. • Deformity:
 Obvious deformity is an obvious sign of fracture/dislocation
 Some diagnosis can be made just by looking at the deformity
 Deformity may be absent in cases of impacted #
EXAMINATION:

11. Tenderness:
• Pain elicited by direct or indirect pressure
Direct Pressure:
• Localized tenderness on subcutaneous bone, elicited by
gently running the back of thumb
• Can differentiate between ligament and bone injury
EXAMINATION:

12. EXAMINATION:
Indirect Pressure
• Pain elicited by applying pressure away from
the site o fracture.
Springing test:
• Pressing two bones towards each other away
from site of #

13. EXAMINATION:
Axial Pressure:
• Pressure along 2nd metacarpal will elicit pain
in scaphoid fossa, in case of scaphoid #

14. EXAMINATION:
 Bony irregularity:
• Feeling of bony elevation and depressions in
fractures of subcuteanous bone such as Tibia
• This is definite sign of fracture

15. EXAMINATION:
Abnormal mobility:
• Normally movement occur only at joints
• In fracture there Is mobility at sites other than
the joints
• Abnormal range movements at joints

16. EXAMINATION:
• Absense of transmsitted movement:
• If a bone is moved holding it at one end, the
movement can be felt at the other end
• This is absent in displaced #
• In case the # is undisplaced or impacted, the
movements will be transmitted even in the
presence of a fracture.

17. IS IT AN OPEN FRACTURE?
• It is important to ascertain whether the
wound is communicating with the fracture
• It is easy as one may see the bone under the
wound
• If it is difficult to know then it should be taken
as open fracture

18. IS IT A PATHOLOGICAL FRACTURE?
A pathological # must be suspected if:
• The force producing fracture is insignificant
• There is a H/O pain or swelling in the affected
bone prior to the occurance of #
• There is history suggestive of frequent # in the
past (eg- osteogenesis imperfecta)
• Patient is suffereing from a debilitating systematic
illness known to weaken bones

19. •THANK YOU
•To be continued…