All patients with major trauma (even if there is no obvious chest injury).There is no need to routinely X-ray the lumbar spine of patients with acute back pain without trauma. The whole thoracic and lumbar spine should be X-rayed routinely in all patients with multiple injuries (though this need not be done as an emergency procedure in the resuscitation room). The spine should always be X-rayed in patients with back pain following trauma when there is bony tenderness, diminished movements, or where one cannot fully assess the back because of other injuries. There is no need to routinely X-ray the neck in patients with neck pain in the absence of trauma. The cervical spine must also be X-rayed in anybody with neck pain following an injury unless they fulfil the following 5 criteria *Īlternatively, the Canadian C-spine rule can be utilised. The cervical spine must be X-rayed in all patients who have suffered a head injury or blunt trauma above the clavicles, and in whom you cannot assess the neck because of, diminished level of consciousness, alcohol etc. haemarthrosis - any intra-articular fracture will cause a haemarthrosis (unless there is an associated capsular tear) and so a joint with no effusion and a full range of movement can usually be assumed not to have an intra-articular fracture.bony tenderness (it would be unusual to have a fracture which was not tender). rib, nose or toe.įactors which one should look for on physical examination are: The presence of a fracture need not alter patient management, e.g.The mechanism, history and examination do not suggest a bony injury.When there is a possibility of glass in a wound.altered consciousness, peripheral neuropathy, major learning difficulties. If there are assessment difficulties, e.g. osteogenesis imperfecta, steroid therapy, known malignancy (possibility of pathological fracture), recent injury or metal in situ.
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