Case in the Spotlight 10


Answer 1

Identity – confirm you have the correct registrar on call, introduce yourself and identify the patient and have UR number.

Situation – you suspect your patient has a fracture

Background – “multiple medical problems”… or “reasonably fit and well” will suffice for the initial info to the ortho reg. You should have more information available on request.

Assessment – non weight bearing, neurovascular status is intact, locally tender, you think there is a fracture

Request – a review of the radiology and recommendations for further tests or management

Answer 2

Providing plain language fact sheets is one of the better ideas in clinical medicine. This is a lot of information out there, and you should be better qualified to look up “Dr Google” than your patients. They will look for information, so you may as well be well informed in advance.

Answer 3


Key features you should know re tibial plateau fractures

  • Tibial plateau fracture is an important injury to recognize.
  • Usually seen in plain x-rays, but if not displaced may be missed.
  • High index of suspicion required if patient cannot walk
  • Like elbow fractures, an effusion may be seen which is an important clue re occult fracture. This includes the signs of lipohaemarthrosis (see link to image below)
  • CT scan will be required

                      - When plain radiography is inconclusive, yet clinical suspicion remains high.

                      - To more fully delineate the extent of injury – therefore most patients who cannot walk or

                         have a fracture on x ray will get a CT scan.

Answer 4


Orthopaedic HMO2 reading program

Interested in orthopaedic surgery, need more detail?
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