Fractures easy to miss (general practice)

The following are fractures until proved otherwise:

• impacted hip fractures - pain or walking difficulty after a fall in an elderly person
• impacted fracture of humerus or distal radius - the degree of pain may be the only clue
• greenstick fracture of forearm - degree of pain or typical site of pain especially in a child
• wrist pain may be a scaphoid fracture (common cause of litigation against doctors because of the degree of permanent disability) - record whether there is scaphoid tenderness at the anatomical snuffbox - treat the tenderness as a fracture despite a normal Xray report
• fractures of the lateral malleolus can be misdiagnosed as a sprain if swelling is extensive - if in doubt, refer
• injuries in paralysed or unconscious patients or who have neuropathy, eg diabetes or MS, are very easy to miss
• rib fractures occur twice as often as appear on Xrays. Treatment is usually unaffected.