Last week I worked with a resident. She had recently completed a rotation at The Big Pediatric Hospital, in the ED. One of her stories involved a child with a fracture. She related that, as she was showing this child her fracture on the x ray, the child exclaimed, “That’s the broken part, isn’t it?”
This stimulated me to recall a tale of my own (for, does not nearly EVERYTHING, stimulate me to recall a story?). Long ago and far away, I was working urgent care at a distant clinic. In this facility, my MA was an x ray tech, going to school for MRI. One day, a family brought in the matriarch, who had hip pain after a fall. Indeed, this elderly woman was pained by the movement elicited by the cracks in our flooring (our flooring was in very good repair!) Well, (let us call my MA…) “Ashley” determined that there was an x ray in this lady’s future, and figured that one movement onto the x ray table might be superior to a move into the room, an exam, another move into the x ray room, and THEN onto the table. Good call.
Ashley took only one image, before exiting the x ray room, at speed, and summoning me. “Reltney, you need to see this film”.
“Oh? Is it interesting?”
“Well, I believe you will be irate if you delay another minute before you see this film. I think that it will have a serious impact on your medical plan of care!”
Well, alrighty, then!
I had previously casually mentioned the concept of “the ophthalmologic fracture”. That is a break so obvious, so lacking in radiologic ambiguity, that should an ophthalmologist happen by, that physician would stop in his/her tracks, do a double take, and exclaim, “Hey! That looks broken!”
This lady had a ophthalmologic fracture of her hip. I had Ashley copy this image on a CD, and had my clerk summon EMS. I called The Local Trauma Center, and described the events to the attending physician. Once EMS had arrived, I invited them to view the film. They were, as well, impressed. She was backboarded, and transported to the hospital for further evaluation and care.
My physician colleague (remember her? She led me into this tale, after all!) nodded. I concluded, “You, doctor, have just introduced me to the concept of “the pediatric fracture: a break so obvious that a child can identify it”!
Musings of A Stretcher Ape 
And yet, we radiological technologist students (we dare not say x-ray tech) were required the answer the question “Is it broken?” with “I am neither qualified nor permitted to make an assessment; that’s the job of the radiologist.” An older gentleman was on his way to our clinic for a colonoscopy but fell down his stairs, resulting in a finger with bends that weren’t there before. I took the pic. Yow, I thunk. I believe those finger parts should be somewhat near each other. “Is it broken?” “I can neither, etc” while vigorously nodding my head. It was friggin’ obvious. I was wrong. Dislocated. Poor guy had to do the colon prep again later. Moral: I made a better electronics tech than I did an RT. Or something.
LikeLiked by 1 person
I get that point. Yet, before I will attempt to reduce a dislocation, I want a film, because I’m not gonna yank on a bone with a fracture.
Besides, imaging a “Nursemaid’s Elbow, more often than not, results in my friend the tech, reducing that dislocation, in the course of imaging it!
LikeLiked by 1 person