No Fracture, No Problem?

​"It's been hurting for months, but now I'm really having pain and difficulty walking too."​The resident relayed those words said by a 60ish-year-old woman in our emergency department. Now the resident was waffling over whether to get an x-ray. On one hand, ordering radiographs will increase her length of stay, and will certainly not show a fracture. On the other hand, the patient's satisfaction might improve by taking some pictures. The resident decided to do the x-ray; adding it probably won't help much anyway.​The AP film seemed to confirm his fear of wasted time and resources.When the lateral popped up on the screen, however, those feelings vanished.​The patella seemed almost adherent to the anterior femur. There was no joint space left, and there were huge osteophytes. It would seem that this lady could benefit from a patellofemoral replacement. The patient was shocked to learn that she wouldn't need the entire knee replaced. There were three compartments to the knee, and only one of hers was bad. Funny, both she and the resident were happy to have the x-rays. Even though there wasn't a fracture, there was a diagnosis.Tip to Remember: Tricompartmental arthritis includes the articular surface of the medial tibial, lateral tibia, and the patella. It is possible to replace one, two, or all three.​Tags: knee pain, fracture, x-ray, tricompartmental arthritis, patella, osteophytes, diagnosis, emergency medicine, emergency departmentPublished: 12/1/2017 ...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs