GENERAL PRINCIPLES OF DIAGNOSIS AND TREATMENT
Clinical Examination of Traumatic Patients
Special considerations
Diagnosis of injuries is made using conventional clinical methods. To verify the diagnosis special investigations are used.
History. Delineating the cause of the trauma facilitates diagnosis and prevention of the trauma. The mechanism of the trauma can be deduced from the patient's history, which coupled with the initial impression may help outline the workup (e.g. falling with one's arm outstretched results in a radial fracture in a typical site or a fracture of the humeral head; falling from a height and landing on the buttocks leads to a compression fracture of the lumbar spine, etc.).
Inspection. Inspection of the patient and the injured area even without special equipment can be of diagnostic value. It is a must to compare the injured side of the limb with the intact one. In examining the affected organ the three main positions are to be considered: passive, active or forced.
Passive position of the whole body suggests a serious injury and is characteristic of an unconscious patient (e.g. in head or spinal injuries with possible palsy). A passively placed limb is typical of fractures (e.g. in femoral neck fractures, the fractured leg is found rotated outside; when a major nerve is injured there can be passive positioning of the limb without active movements etc.).
Forced position of the limb occurs in displacements and in the acute phase of fractures or in inappropriately healed fractures and development of ankylosis.
On inspection, the skin pallor and hyperaemia are to be noted, as well as skin hydration (dry hot skin/cold sticky sweat), the presence of abrasions, bruises, their localisation, size or colour etc.