Sunday, March 17, 2013

Diagnosis Of The Week

My batting average at diagnosis/guesstimating fractures is nearly a perfect 1.000 average. By which I mean, I've been, I recollect, 100% wrong when thinking a bone is fractured, and complementarily 100% wrong when thinking a bone isn't fractured. This has been confirmed by diagnostic radiology studies in a lengthy host of instances. I note with some measure of reassurance that many of my colleagues are similarly handicapped in the Superman x-ray vision department. Which is why my default answer to someone is that we need to get an x-ray and actually see.

The one exception to this abysmally bad knack for prognostication is the subject of today's little chat. That exception is the Stevie Wonder Fracture. Some people who aren't radiologists or orthopedists, and are doubtless destined to be future Final Jeopardy contestants, may pride themselves on knowing every obscure type of bone fracture in the atlases and professional references.

You will not, however, find the Stevie Wonder Fracture listed therein.
Fortuitously though, it needn't be.
Because, quite simply, any anatomical structure with an underlying osseous substrata which is so obviously malformed as to require a broken bone is, in fact, a Stevie Wonder Fracture.

When 10 year old arrives, self-splinting a forearm in the shape reminiscent of the Mark Of Zorro, and it's so brokedy-broke that a blind person, without any medical training whatsoever, and forced to assess solely by Braille, would diagnose a broken bone, you have sighted (pardon the unintentional irony) a Stevie Wonder Fracture.

When the wannabe ski bunny arrives, and I or one of my colleagues tells you, in a style reminiscent of Blaine Edwards/Damon Wayons in the "Men On" segments of In Living Color, that your arriving patient has a leg with "3 snaps in a Z formation", you can report to the doctor with 0% chance of error that the patient has a Stevie Wonder Fracture.

Nota bene that there is no requirement for the bones to be currently nor at any time subsequent to original injury, actually protruding through skin to any degree. The true benefit of the Stevie Wonder fracture diagnosis is that it doesn't rely on such cheap parlor tricks as actually seeing the jagged fragment of a formerly intact bone in order to justify the diagnosis. And besides, that'd be cheating.

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