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Posted on 8/16/17 at 7:04 pm to STEVED00
As a college trainer, we were always told to err on the side of caution and refer for an X-Ray (and we had one in site anyway).
That said, if it's a tiny hairline fracture it can be missed. You don't miss a fractured fibula to that degree though.
That said, if it's a tiny hairline fracture it can be missed. You don't miss a fractured fibula to that degree though.
This post was edited on 8/16/17 at 7:05 pm
Posted on 8/16/17 at 7:06 pm to BluegrassBelle
quote:
You don't miss a fractured fibula though
sure you do...syndesmotic injury, athlete complains of ankle pain, ankle films negative. Nobody bothers to order tip/fib films to see fibular neck fx. I see it missed by physicians and mid levels all the time...
Posted on 8/16/17 at 7:12 pm to YipSkiddlyDooo
This doesn't sound like a maisonneuve fracture, IMO.
Posted on 8/16/17 at 7:41 pm to LZ83
quote:
would like to see the X-ray.
This.
Are we talking about a micro fracture that requires an MRI to see.
EVERYTHING in a hospital setting is sent to a radiologist for another set of eyes. Or they are out right the only one reading the X-ray.
I realize with NFL teams they are dealing their own equipment.
Posted on 8/16/17 at 7:51 pm to LSU alum wannabe
He already had hardware. If the orthos couldn't see anything why not refer film to radiologist. This is the NFL and this is a starter money isn't an issue.
Posted on 8/16/17 at 9:14 pm to YipSkiddlyDooo
All the time? Probably not. Extremely rare to see maisonneuve with negative ankle radiographs.
Posted on 8/16/17 at 9:18 pm to STEVED00
Don't tell deltadoc or whatever that idiot's name is that this guy was a MD!
Posted on 8/16/17 at 10:29 pm to Parallax
Thanks for the update. Something didn't sound right from the beginning of this story, and that makes all of this make more sense. I agree that the Saints unjustly shamed these docs publicly, obviously as an attempt to save face for allowing the media to basically tell the rest of the NFL that they thought the guy who came back to play pro football after breaking his neck was a pussy while openly trying to trade him.
Posted on 8/16/17 at 11:03 pm to suman
quote:
All the time? Probably not. Extremely rare to see maisonneuve with negative ankle radiographs.
A true negative ankle film? Sure. But most of them I get aren't truly negative. They have subtle decrease in tib/fib overlap or widening of the medial clear space or both. However, a radiologist from our hospital or an outside facility has "read" them as negative (which is why I said "ankle films negative"). I treated several hundred operative and non operative ankle fxs last year. If you think it is extremely rare to get a referral for an ankle sprain because the ED, UC or PCP only ordered ankle films that a radiologist read as negative...only to find out they have a neck fx...you should go hang out with an orthopod.
That being said, I have no idea what was missed in this case or how. I was simply responding to the dumb that was trying to sneak into this thread. Remember, there was someone in here who said fracture=/=break
This post was edited on 8/16/17 at 11:24 pm
Posted on 8/16/17 at 11:08 pm to STEVED00
Ot docs-
What type of dr should i see for a back pain diagnosis? Don't want to see a chiropractor, just want to know the source of the pain. Neurologist?
What type of dr should i see for a back pain diagnosis? Don't want to see a chiropractor, just want to know the source of the pain. Neurologist?
Posted on 8/16/17 at 11:21 pm to S
If you don't have obvious known trauma then a neurologist would be good. If you had a known injury/cause of the pain then ortho spine would be fine. Either way I wouldn't bother with a chiropractor (if conservative care is recommended after an actual diagnosis from a doctor then a physical therapist can help with that and many are trained in doing "manipulations"). I wouldn't start at a pain management doc either since they are typically anesthesiologists who are great with drugs and injections/blocks but I don't know I'd want em to work me up if this is new/unknown/unexpected pain. Maybe the fellowships are getting better for them. Neurologist probably knows a good one or two in your area if he feels like you'd benefit from intervention.
Posted on 8/17/17 at 12:37 am to MrSpock
quote:
An xray cost 10 bucks and takes 4 seconds. Pretty egregious mistake.
Didn't read the story. Small fractures often don't show up on x-ray early. With high index of suspicion (or high risk, such as a guy on an NFL roster), you bring him back and reshoot the films, typically, and things can be more clear.
But if he can bear weight, strength is fine, just has some tenderness without deformity, it's reasonable to have a delayed diagnosis.
Posted on 8/17/17 at 12:39 am to S
quote:
What type of dr should i see for a back pain diagnosis?
Seen no one yet? No trauma? Internal medicine, Family medicine, or a medicine (not surgery) Sports Med fellow trained guy.
Posted on 8/17/17 at 11:11 pm to Parallax
quote:
This doesn't sound like a maisonneuve fracture, IMO.
Kind of hard to miss this fx if you're a competent MD. And a Masisoneuve fx involves the proximal fibula, not down by the ankle. Yes, you will likely have widening of the tibiofibular clear space in the ankle, but the distal fibula shouldn't be fractured in the mechanism that causes a Maisoneuve fx.
Posted on 8/17/17 at 11:20 pm to STEVED00
quote:
maybe we are missing something
Like it wasn't actually broken the first time and Payton made him work out on it for weeks until it broke then covered his arse when it was discovered in an trade by scapegoating the doctors?
Posted on 8/18/17 at 12:15 am to PurpleFin
quote:
He already had hardware.
From the reports the break/fracture was right under the hardware. Probably why they missed it or it could be a number of other reasons.
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