Examination for Some Commonly Missed Fractures

Hand pain

Hyperextension of the hand and wrist

Tenderness on the dorsal wrist

Triquetrum fracture

Elbow pain

Fall on outstretched hand

Elbow pain when supinating and pronating the forearm

Radial head fracture

Wrist pain or swelling

Fall on an outstretched hand

Tenderness over the anatomic snuffbox (located just distal to the radius, between the extensor pollicis longus, extensor pollicis brevis, and abductor pollicis longus tendons)

Scaphoid fracture

Various mechanisms

Tenderness over the lunate fossa (in the wrist at the base of the 3rd metacarpal) and pain with axial compression of the 3rd metacarpal

Lunate fracture

Lunate or perilunate dislocation

Hip pain

Fall

Pain during passive hip rotation when the knee is flexed

Inability to flex the hip

Leg externally rotated and shortened

Inability to bear weight even though plain x-rays are normal (particularly in patients with osteoporosis)

Hip fracture

Knee pain in a child or an adolescent

Various mechanisms

Pain during passive hip rotation when the knee is flexed

Hip injury (eg, slipped capital femoral epiphysis, Legg-Calvé-Perthes disease)

Ankle pain

Fall or step into hole

Twisting mechanism

Swollen and tender ankle

Tenderness of lateral knee

Maisonneuve fracture (spiral fracture of the proximal third of the fibula plus a tear of the distal tibiofibular syndesmosis and the interosseous membrane)