'Don’t Do That Again!'

It's 2 a.m. I glance up from my computer screen where I have been diligently clicking boxes on the EMR to see a 20-something man hobble down the hallway following the nurse to a hallway bed. His left foot had a normal heel strike, but the right always came down on the ball of the foot. Curiosity piqued, I opened a new tab to consider this patient's problem.The 28-year-old jumped over a fence to get away from a dog, landing on his right heel. He said he had not been able to put pressure on the back of his foot since the injury occurred an hour earlier. It was a pleasure to have something so straightforward.I checked for an intact Achilles' while I watched for plantar flexion with a squeeze of the calf muscles, and then evaluated for tenderness or defects by directly palpating the tendon. Then I cupped my hand around the heel squeezing in all directions. The directive "don't do that again" virtually confirmed my suspicion that this young man suffered from a calcaneal fracture. I told him as much as I placed the x-ray order. ​Seeing the patient wheeled back to his bed,  I popped up the images on PACS. What? It looked pretty normal. Where was that fracture that had to be there?  There was a small sclerotic line across the tubercle, but that wasn't enough for me make the call.  Sure, I could just treat him like a fracture and hope that he followed up. Still, I really wanted to know. Thinking about the options, I came up with three:n Send to...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs