Page 149 - ASOP ROT Study Guide
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about the injured person's previous general medical state. Often, medical conditions may be
associated with an injury. For example, the injured person may have had a fit or may have
collapsed with a hypoglycemic attack because she/he is diabetic. In the elderly in particular, a
fracture may have occurred as a result of a fall during a heart attack or a stroke.
Many patients with fractures may need an anesthetic and so the condition of the cardiovascular and
respiratory system must be established. The last time the injured person ate or drank must be
ascertained so that surgery can be delayed, if possible, until the stomach is empty to reduce the
risk of breathing in vomit.
♦ Who is the person?
Finally, when circumstances permit, a social history is important. The status of the injured person
before the injury must be established. Where do they live and with whom? Do they have stairs to
climb into the house or flat or within the home? Can the older injured person go to relatives after
any hospital stay to rehabilitate? The planning of recovery starts with admission to hospital and not
as an afterthought just before discharge. Sending an old person home to a cold top floor flat with
no heating and no relatives on a Friday night, with no social provision, is of no benefit to the
injured person, no matter how well the fracture has been treated in hospital.
2.2 Medico-legal Aspects
Accidents have all sorts of consequences. They will affect the victims personally, and their
families. They will also, depending on the circumstances, have effects relating to insurance and
litigation.
Therefore it is important to keep meticulous notes and to make them at the time of examination and
treatment, or as soon afterwards as possible. Legible and complete notes are essential as it is often
months or even years before a doctor may be called to give an account of an accident.
3. CLINICAL EXAMINATION
Suspicion of a fracture may have arisen from the history of the accident. This diagnosis can first of
all be tested by clinical examination for the signs of a fracture. The signs of a fracture are
described below.
3.1 The Signs of a Fracture
3.1.1 Pain
As we have already stated, a fractured bone is painful. The injured person will be able to tell the
doctor if she/he is experiencing pain. A limb with a suspected fracture should never be moved
suddenly and never without support from a splint. The doctor should ensure that the injured person
has adequate pain relief.
3.1.2 Deformity
A fractured bone may result in a change in the normal appearance of the injured part. The position
of the distal fragment of a fractured bone is determined by gravity, this is to say it can move under
its own weight. The position of the proximal fragment is determined by the muscles. Sometimes
the deformity is influenced by the direction of the force which caused the fracture. 3.1.3
Tenderness
As well as being painful, the area around a suspected fracture is tender - it hurts when touched
or pressed as in Figure 3.
