Chapter 2. Methods of examination in traumatology and orthopedics

"Diagnosis" translated from Greek means "recognition".

Clinical diagnosis is an obligatory condition for the correct treatment of patient. V.O. Marx (1978) notes that excellent equipment of clinics by modern equipment leads, paradoxically, to that fact that some physicians consider it possible to ignore complete clinical investigation of the patient. This course of action cannot be considered as correct - it is rather a step backward than forward.

Examination of patients with injuries and diseases of the musculoskeletal system is based on general principles adopted in medicine, on a good knowledge of propaedeutics, with the taking into account the specific features of traumatology and orthopedics.

An approximate scheme of the patient's examination

1. Clarification of complaints.
2. Taking medical history:
   • history of present illness (anamnesis morbi);
   • history of life (anamnesis vitae).
3. The present state of the patient:
   • general examination and physical investigation of the patient (status praesens);
   • examination and investigation of the site of injury or disease (status localis).

In this case, the following techniques are used: assessment of posture, gait, anatomical contours, palpation, percussion, auscultation, study of peripheral blood supply and innervation of the limbs, determination of deformities, range of motion in the joints, measurement of the length and circumference of the limbs, determination of muscle strength.

1. Instrumental methods of diagnosis:
   • non-invasive - radiography, fluoroscopy, computed and nuclear magnetic resonance imaging, ultrasound examination, scintigraphy, angiography, electrophysiological, biomechanical examinations;
   • invasive - puncture, biopsy.
2. Laboratory diagnostics. Laboratory methods can be separated into a group, or classified as instrumental methods, since their implementation requires taking of material for analysis and the use of appropriate equipment.

After the examination of the patient, a diagnosis should be established.

Examination of patients arriving with fresh injuries (traumatological patients) and with the consequences of injuries or diseases of the musculoskeletal system (orthopedic patients) is carried out in different conditions and, therefore, has certain differences.