Figure 1. Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID: 26332
Have you ever been working a shift at 3 AM and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their PCP in 1 week.” This is a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify injuries that ideally should not be missed. This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries. We’ve already covered the adult elbow, wrist, shoulder, ankle/foot, and knee. Now: the hip.
A 32-year-old female presents to the emergency department with right ankle pain after a high-speed motor vehicle accident. On exam, she is noted to have ecchymosis and swelling over the distal foot, and pain with ankle dorsiflexion and plantarflexion. An x-ray is obtained as shown above (Image 1. Case courtesy of Dr. Charlie Chia-Tsong Hsu, Radiopaedia.org, rID: 18235).
A 35-year-old male felt a painful “pop” in his posterior left lower leg while playing football. Afterward, his “foot didn’t work right anymore.” X-ray of the left ankle and tib/fib was normal but he was unable to ambulate. You plan an ultrasound over the area of maximal tenderness and discover the above image (Image 1.Ultrasound of the left posterior ankle 11cm proximal to the calcaneal insertion of the Achilles tendon. Case courtesy of Robert Lystrup.)
Figure 1: Initial radiographs in the ED with the elbow slightly flexed.
Figure 2: AP and lateral radiographs of the elbow.
An 18-year-old male presents with a painful and swollen left thumb. He removed a splinter from his finger a few days ago however, 2 days after removal, he began to experience edema and pain that has progressively gotten worse. An image of his finger is shown above (Image 1. Picture courtesy of Rosh Review [1]).
Figure 1. AP and Lateral x-rays of the right knee. Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 16139