Ortho History and Physical

Hi
I was wondering if any resident out there could give a 4th year student some tips on what the essentials of an ortho directed history are, as well as the physical exam.

Are there absolute "do not misses" or things to definitely leave out when presenting a case on a busy ward?

Thanks

T

never miss neurology.
examples where you can be sure that these questions will be asked:
foot drop in fibula-head-fracture?
hand drop in humerus-fracture?
same for spinal stenosis and prolaps.

Patient name, age, past medical history.
Smoking, anti-inflammatory use, previous history of orthopedic injuries/interventions and subsequent complications (malunion, infection).

What my residents always cared about when I was a student describing a fracture:
Is it open? If it is, how long, how deep, is it dirty?
As the above post says,a detailed neurovascular exam is key and can really affect management. Document the exam.
Compartments are ok?
Any other injuries previously missed?

Thats a nice basic approach that worked for me.

Associated injuries are HUGE, particularly if you are working up trauma. Its easy late at night to go to the ER, see an obvious femur fracture, and miss another fracture. It happens several times EVERY year. You DON'T want to be that guy that misses something obvious, move and touch all 4 extremities.

If you are going into a trauma exam, always think about the WORST complications associated with the injury (this will come with time), look for it (i.e. compartment syndrome).( i.e. Knee dislocation, exam for vascular injury). Be compulsive about this stuff.

Regarding outpatient clinic, pay attention to previous surgeries. Diabetes, smoking, history of staph infection (I now ask all my patients this), any past histroy of healing problems. Also blood thinners....

One thing I like to ask, particularly with complicated issues, is "if you could treat one thing, and get rid of it, what would it be?"

When you are a med student, be concise, but know more if asked. Hit the high points, particularly late at night. eastcoast bones nailed it on the head: First thing when calling an upper level or attending, tell them who's speaking first (you would be surprised!), let them know quickly the injury, the condition of the limb (open, closed, stable/unstable)...

You DONT want to be surprised, its all about minimizing complications.

On the wards:
This is Ms. ____, 76yo POD#2 status post L Total Knee.
Give a quick update: She is progressing well with PT, is neurovascularly intact, walking with a walker, h/h, drain status i/o's and if pulled, progress with PT, and PLAN (i.e. discharge planner is waiting for nursing placment, she is stable and ready to go today upon approval).
If you are dealing with infection, know your organism, culture, have a printout of sensativites in pocket, but know the abx they are on and if the bug is sensative to it).

If you are dealing with a trauma patient who is sick, know the status of clearance from the trauma service (i.e. when can we expect to operate??)


If a biopsy was performed (fem neck fracture suspect mets...), know the status of the biospy.