re: OT Medical Drs - How egregious is misdiagnosising a broken leg as a bruise??

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You don't miss a fractured fibula though

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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...

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would like to see the X-ray.

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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.

All the time? Probably not. Extremely rare to see maisonneuve with negative ankle radiographs.

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.

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All the time? Probably not. Extremely rare to see maisonneuve with negative ankle radiographs.

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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

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.

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An xray cost 10 bucks and takes 4 seconds. Pretty egregious mistake. 

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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.

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This doesn't sound like a maisonneuve fracture, IMO.

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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.

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He already had hardware.

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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.