Episode Transcript
Interviewer: You think you may have broken a bone but you're not sure. Is there a way you can tell? We'll find out next on The Scope.
Announcer: This is From the Front Lines with emergency room physician Dr. Troy Madsen on The Scope.
Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health. And I know it seems like a silly question because one would think if I broke a bone I would know for sure that I broke a bone. But personal experience, when I was a kid, I broke a bone in my leg, I didn't know, my dad didn't know. He told me to walk it off, you know, as fathers back in that day did, and it turned out the next day I went to the ER and sure enough it was broken. So how can you tell if you broke a bone if you're not sure?
Dr. Madsen: Well, you know, it's really not a stupid question at all because there have been lots of studies done to answer that question for us. How can I know as a physician if someone possibly broke a bone, in their knee, their ankle, their foot?
Interviewer: And you're talking without doing imaging?
Dr. Madsen: Yeah, exactly.
Interviewer: Okay.
Dr. Madsen: To say, okay, are there cases where I can avoid getting an X-ray, or every time someone comes in and says it hurts here on this bone do I need to get an X-ray? So it's actually a great question. And in terms of ankles, knees, and feet, if you can't walk on it, you need an X-ray. That's kind of what these studies showed. But then they also show there are certain parts where if you push on a part of the knee or the ankle or the foot that are more prone to fractures, then those are people who need X-rays as well. So it's a little bit tough to kind of go through and say, "Well, if it hurts on this spot, you need an X-ray, or this spot you don't, this spot you do, this spot you don't."
That's what it comes down to for me as a physician, I know there are certain areas that are more prone to fractures but, you know, typically with fractures you're going to see a lot of swelling, you're going to have trouble moving that joint around or you push on the bone, it hurts there. Again, it's going to be kind of a judgment call. I would say if you're able to walk on it or you're able to use that joint okay, you might be able to get by. But if after a couple of days you're still having a lot of pain there, I think in my mind that increases the likelihood of a fracture in that bone.
Interviewer: And when you say fracture, that's used interchangeably with broken?
Dr. Madsen: Exactly. And that's a great question because sometimes, you know, if you say to someone, "Oh, you've got a fracture in the bone." They'll say, "Well, is it broken?" But, yeah, that's a great question because those are terms that are used interchangeably. You know, the other things we always think about are sprains, strains, you know, where you're pulling on muscles, you're bruising the bone, these are all possibilities as well, things that can look like fractures or like broken bones but, you know, the biggest thing in my mind in the ER is, is it broken, and do we need to do something about that fracture?
Interviewer: Yeah, on that next question sometimes if it is fractured there is nothing that really needs to be done?
Dr. Madsen: That's right. Yeah. Sometimes if something is broken its maybe in a place where there's really not a concern there. Maybe you need a splint on it, but it's all aligned, you don't need to push things back in place. There may be some fractures that are just little chip fractures, little chips off the bone where there's really nothing at all you're going to do for it. So there are certainly cases where, you know, you may have broken something but it's not a big deal. But in my experience, most cases of broken bones, they at least need a splint or a sling or something to keep that from moving around a lot and making it a lot worse.
Interviewer: So with this information that you have, the studies that have been done and knowing where to press and what to expect, how often do you not have to use imaging now? Can you just tell through a physical examination if the bone is broken?
Dr. Madsen: In terms of what I do in the ER, one of the challenges I face is that I think most people come there and if they're ankle hurts they came there to get an X-ray. So sometimes I do spend time trying to talk them out of getting an X-ray, I would say with the knowledge I have of where it hurts and where it hurts and where it doesn't hurt, and maybe 20% of the time people don't need an X-ray. The other 80% of the time people sort of self-triage, they say, "Hey, I can't walk on my foot. I need an X-ray." And I say, "You're exactly right, you need one."
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