12 January 2009

I am so awesome

Written with the modesty and restraint that most observers agree is my hallmark.


But you must admit, it's terribly satisfying when you see something on the x-ray that the radiologist does not. In this case the initial reading of the above film was "nondisplaced fracture lesser tuberosity." I noticed the little cortical discontinuity on the medial aspect indicated by the "hey dummy sign," (the red arrow) which I thought indicated that the fracture extended all the way through the surgical neck. A diplomatic call to the radiologist, a couple of additional views later, and the diagnosis was confirmed, as seen below. In fairness, it's a lot easier when I have seen the patient and they have not, but that doesn't diminish the pleasure from out-experting the expert!


[/smug]

6 comments:

Anonymous said...

If you look at the first photo from a little distance you can actually quite easily trace the fracture line all the way through the bone. Now the most interesting question is did it affect management? I we would still treat this conservatively as there is only minimal displacement and the articular surface is intact. If so you wouldn't even have needed those additional views in the first place.

Anonymous said...

what is the management difference between the 2 entities?

shadowfax said...

No significant difference. They both do fine in a sling. The surgical neck fracture will take substantially longer to heal and have a lot more pain and disability, so it's good to know. But there's no action item associated with it in the acute setting.

08armydoc said...

WAHOOO.

Ahem.


Now back to our regularly scheduled program

RugbyGirlMD said...

I was smug for a good month when I caught my zinger.

I was an MSIV and I thought the surgeon was just pimping.

I caught a distal femur fx that both the radiologist and the surgeon missed.


Go you!

physasst said...

I love the ankle films that demonstrate a proximal fifth metatarsal fracture. Jones, or avulsion, which the radiologist misses. Seems to happen a bit.