Bone Fracture: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; further:
    • Inspection of the injured body region
      • Dolor (pain (periosteal pain))
      • Tumor (swelling)
      • Rubor (redness)
      • Calor (warmth)
      • Functio laesa (restricted mobility/loss of function); Caution! Elbow extension test after trauma does not rule out a fracture!
      • Hematoma (bruise)
      • Open vs. closed fracture
      • Abdomen (abdomen)
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Inspection (viewing) of the skin and mucous membranes.
    • Auscultation (tapping) of the heart
    • Examination of the lungs (due topossible sequelae of fractures of the ribs or clavicle (collarbone):
      • Auscultation (listening) of the lungs.
      • Bronchophony (checking the transmission of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the doctor listens to the lungs)[in the case of reduced sound conduction (attenuated or absent: for example, in pneumothorax). As a result, the number “66” is barely audible to absent over the diseased portion of the lung because the high-frequency sounds are greatly attenuated]
      • Percussion (knocking sound) of the lungs [box sound in pneumothorax].
      • Vocal fremitus (checking the transmission of low frequencies; the patient is asked to pronounce the word “99” several times in a low voice while the doctor places his hands on the patient’s chest or back)[severely attenuated or absent: in pneumothorax). As a result, the number “99” is barely audible to absent over the diseased lung area, as the low-frequency sounds are greatly attenuated]
    • Palpation (palpation) of the abdomen (abdomen) (pressure pain?, knock pain?, cough pain?, defensive tension?, hernial orifices?, kidney bearing knock pain?)
  • Cancer screening [due topossible causes:
    • Malignancies (malignant tumors).
    • Metastases (daughter tumors)
    • Plasmocytoma (synonyms: Multiple myeloma, Kahler’s disease; malignant tumor of plasma cells)]
  • If necessary, neurological examination [due topossible secondary diseases:
    • CRPS (Complex Regional Pain Syndrome) – Complex regional pain syndrome; chronic neurological disorder occurring after soft tissue or nerve injury.
    • Nerve or vascular injury (circulatory disturbances/disorders of motor function and sensitivity)]
  • Orthopedic/rheumatologic examination[due topossible causes:
    • Diseases of the rheumatic form circle (e.g., ankylosing spondylitis/ Bekhterev’s disease).
    • Gorham osteolysis – osteolysis (bone dissolution) after traumatic impact on the bone.
    • Intestinal osteopathy – skeletal changes due to malabsorption (inability to adequately absorb nutrients).
    • Jaffé-Lichtenstein syndrome – Osteofibrosis deformans juvenilis (systemic disease of the skeleton that begins in childhood and can affect only one bone (monostotic) and affect multiple bones (polyostotic). Due to marrow fibrosis (abnormal proliferation of connective tissue) and spongiosis (porous-spongy, pathological remodeling of bone tissue) of the compacta (outer marginal layer of bone), the affected bones lose load-bearing capacity).
    • Bone cysts
    • Paget’s disease or Paget’s syndromes Paget’s disease (synonyms: osteodystrophia deformans, Paget’s disease, Paget’s disease) – disease of the skeletal system in which there is gradual thickening of several bones, usually the spine, pelvis, extremities or skull.
    • Osteogenesis imperfecta (brittle bone disease).
    • Osteomalacia (bone softening) – mineralization disorder of the bone e.g. disturbances in vitamin D metabolism.
    • Osteitis / Ostitis (bone inflammation)
    • Osteomyelitis (bone marrow inflammation)
    • Osteopetrosis – marble bone disease/osteopetrosis familiaris/osteosclerosis congenita
    • Osteoporosis (bone loss)
    • Osteosclerosis – compaction of bone tissue with loss of elasticity.
    • renal (ren – kidney) osteodystrophy / rickets renalis – disturbance of vitamin D metabolism or attack of the bone by accumulation of urinary substances]

    [due todifferential diagnoses:

    • Degenerative skeletal changes
    • Hereditary skeletal deformities
    • Diseases of the rheumatic type
    • Contusions (bruises)
    • Luxations (dislocations of joints)
    • Osteopathies (generalized skeletal diseases of various origins).
    • Sprains
    • Soft tissue injuries (musculature, etc.)]

    [due topossible secondary diseases:

    • Ligament injuries
    • Fatigue fracture
    • Fracture healing disorders – e.g. pseudarthrosis (joint deformity).
    • Myositis ossificans – ossification of the muscles due to pathological calcification after trauma.
    • Osteomyelitis (bone marrow inflammation)
    • Post-traumatic osteoarthritis (joint wear and tear occurring after an injury).
    • Refracture (reoccurrence of a bone fracture)]

Square brackets [ ] indicate possible pathological (pathological) physical findings.