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A structured approach to evaluating acute musculoskeletal injuries may help reduce missed diagnoses and unnecessary imaging, according to a review article published in Cureus. Musculoskeletal complaints account for an estimated 20%–25% of emergency department visits, and the authors explain that combining injury mechanism, functional assessment, focused physical examination, and targeted imaging can help identify significant injuries. Validated clinical decision tools can safely reduce unnecessary radiographs while still achieving accurate diagnosis, they say. For example, the Ottawa Ankle Rules demonstrate near-100% sensitivity for clinically significant fractures while decreasing imaging by approximately 30%–40%. The review also notes the value of point-of-care ultrasound for identifying musculoskeletal injuries. At least 20 different injuries are listed in the review with physical examination maneuvers and imaging considerations.
Deeper evaluation: As one example of the framework, the authors highlight Lisfranc injury as a commonly missed diagnosis. Clinicians should suspect Lisfranc in patients with midfoot pain after an axial load or twisting injury, particularly for patients with plantar ecchymosis, tarsometatarsal tenderness, or inability to bear weight. Because standard radiographs may appear normal, the review recommends weight-bearing foot radiographs and computed tomography if clinicians still have suspicion of Lisfranc injury. Read about Lisfranc management from the JUCM archives: Urgent Care Evaluation and Management of Suspected Lisfranc Injuries and tap into JUCM’s entire library of orthopedic case reports on the JUCM website.
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