Bone or joint injury

Rationale

Bone and joint injuries, such as fractures or dislocations, are a frequent cause of musculoskeletal pain and may contribute to permanent disability or premature death. Bone and joint injuries may be associated with other injuries that may take priority. Unexplained bone or joint injuries should alert physicians to the possibility that the patient is being abused.

Causal Conditions

(list not exhaustive)

1. High-energy trauma
2. Nonaccidental injuries (e.g., intimate partner violence)
3. Falls
4. Pathologic conditions predisposing to injury (e.g., osteoporosis, ligamentous laxity)

Key Objectives

Given a patient with a possible bone or joint injury, the candidate will diagnose the cause, assess the severity of the injury, identify possible complications, and construct an appropriate management plan. The candidate will also recognize circumstances in which the patient may have an increased risk for fracture.

Enabling Objectives

Given a patient with a bone or joint injury, the candidate will

1. list and interpret critical clinical findings, including those derived from a thorough patient history and physical examination, including
   1. the mechanism of injury and, when required, exclusion of other immediately life-threatening injuries through targeted examination,
   2. neurologic and vascular status,
   3. symptoms and signs suggestive of abuse,
   4. a history of recurrent falls,
   5. risks for bone abnormalities and/or increased risk for falls or injury, and
   6. signs of pathologic fractures;
2. list critical investigations and interpret the results of the investigations, including
   1. appropriate imaging modalities, and
   2. bone density testing and investigations for causes of osteoporosis if relevant;
3. construct an effective initial management plan, including
   1. determining if splinting or casting is indicated,
   2. restricting weight bearing if indicated,
   3. prescribing analgesics and anti-inflammatory medications as required,
   4. referring to specialized care if necessary, and
   5. choosing the correct treatment for prevention of fractures, including pharmacologic and nonpharmacologic treatments;
4. provide follow-up care and address
   1. the duration of immobilization if any,
   2. returning to work and/or normal activity,
   3. appropriate referral to other health care professionals as needed (e.g., physiotherapist, occupational therapist),
   4. complications requiring further treatment or referral (e.g., complex regional pain syndrome, compartment syndrome), and
   5. factors that will affect recovery from the injury (e.g., living situation, employment, nutrition, substance use disorder, general health).