EXAMINATION OF BONE AND JOINT

INJURIES
History

● Age
● Occupation
● The nature of violence
How did it occur,what was the mechanism, how forceful
was?(pathological fracture-trivial fall)
 History (contd…..)
● Nature of violence( high velocity/ low velocity injuries)
A)Direct-
Penetrating injuries
Crushing
 History (contd…..)
● Nature of violence
B)Indirect -
Twisting-spiral
Bending force-transverse/oblique
Bending with axial compression-butterfly fragment
 History (contd…..)
● Nature of violence
C)Forceful Muscular contraction/ avulsion fractures
Patella,olecranon,lesser trochanter fracture
D) Stress fractures
March fracture
 History (contd…..)
● Pain
Site,
Character,
Relation to movements
● Locking
● Deformity
● Loss of function-unable to move the fractured
limb,unable to walk
● Deformity or swelling
● Loss of transmitted movements
● Past history-

● Family history
General examination

Infants- osteogenesis imperfecta

Dwarfism,broad skull,blue sclera,scoliosis,ligament
laxity,osteosclerosis
Childrens- acute osteomyelitis, solitary bone cyst
Young adults-osteoclastoma,osteosarcoma
Adults -fibrocystic disease,multiple myeloma
Elderly -senile osteoporosis,pagets disease, secondary
carcinoma
Local examination

The injured side should compared with sound side

Examination headings

● Inspection
● Palpation
● Movements
● Measurements
● Special tests
 Local examination
A) Attitude
B) Inspection
swelling
Deformity
Shortening
Overlying skin
Muscular wasting
Engorged veins
Discharging sinus
Local examination
B) Palpation
1.Local rise of temperature
2.Tenderness
3.Bony and soft tissue prominance palpated; look for thickening,
irregularity
4.Abnormal mobility
5. Crepitus
6.Pain elicited by manipulation
C)Movements

Active
Passive

Good active and passive movements mean there is no bone or

joint injury
Always check association of movements with pain and creptius
Movements

● All the movements of joints should assessed

e.g,flexion,extension,abduction,adduction,external rotation
and internal rotation
● If any difference between active and passive
movements,has to be documents
● The range of motion of joint has to be measured
● The terminal limitation if any because of pain/mechanical
block has to be documented
● Complete absence of movements seen in bony ankylosis
● Jog movements seen in fibrous ankylosis
● Terminal limitation of all movements seen in synovitis
● 40-70% loss of movements seen in arthritis

● Excessive movements(> normal range of movements) of

joints seen in connective tissue disorders like Ehlers danlos
syndrome and ligament ruptures
 Fixed flexion deformity (FFD):

● Fixed deformity beyond which opposite movement not

possible, further range of same movement may or may not be
possible
● E.g- 30 degree FFD of hip further flexion till 70 degree limited
by mechanical block
D) Measurements

● Longitudinal
Apparent
True measurements
● Circumference
circumference
Special tests

● Hip -Trendelenberg test,Telescopic tests

● Knee-anterior drawer test,posterior drawer test,mc
murrays test,
● Shoulder- empty can test, glibert lift off test*,full can test,
jobes relocation test,apprehension test
● elbow:
Neurovascular status of limb

● Motor Power
● Sensory
● Distal periphery pulsations
 Investigations
1) X-ray examination
antero-posterior & lateral views
(Situation,line of fracture,displacement,tilt )
Special views
Old fractures-
Signs of union, sclerosis at fractured ends,myositis
ossificans,avascular necrosis
● CT scan
● MRI scan
● BONE scan
● DEXA scan
 Other investigations
B) Serum calcium (hyperparathyroidism pts)
Alkaline phosphatase (high in pagets disease)
Acid phosphatase-(tumours)
C) Urine
(Bence jones proteins,hydroxyproline )
D) Arthroscopy
E) Arthrography
Diagnosis

● Anatomical diagnosis
● Etiological/ Pathological diagnosis
Differential diagnosis

● Acute suppurative arthritis

● Chronic arthritis
● Gout , pseudo-gout
● Charcots joint
● Hysterical gout
● Osteochondritis
● Haemophilic joint
● Cluttons joint
Thank you