Today's case study

うーん...当直明けで
４連ちゃんだとだんだん判断力が鈍ってくるのでしょうか
昨日見逃した骨折の症例を自戒を込めてのせときます

90歳　女性
自宅にて転倒
GPを受診し、？NOF# (query of neck of femur fracture) (大腿骨頸部骨折疑い）にて救急外来受診

左の股関節を痛がっているのですが
股関節可動域はFull Range of Motion
heamatomaもないし、腫れもなし

Pelvis A-PのxRayにて


これを見た私
骨折なし！
自宅に帰ってよし！
と判断

立たせると、やっぱり痛くて歩けないのですねー
骨折はないので、大丈夫なはず？

答え：click!







pubic rami (ramus) fracture でした
　ramiは複数形、特にsuperior and inferior両方のことが多い

Comments

I couldn't tell any sign of fracture from this x-p, first time.
(Is inferior ramus also broke? )

Once I suspected left femoral neck fracture because I thought there may be a gap in left Shenton's line, but at second look, there's none and this film is not true AP so I can't fully rely on this point.

yeah, this is very difficult film form me to read.

My teacher said,"rely on patient's Physical exam, not on X-P first. We are not going to fix this film!"

Posted by foobirds at 2005年10月22日 16:50

>foo-san
Thank you for studying with me! Yes, inferior ramus also broke, but not clear on this photo. I tend to see Xray first when I become busy, but "Physical exam first" is the right way to go.

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