 Here's a recent film fed back to us from orthopaedics. They feel (quite rightly) that something should have been done before this X-ray was taken. Given that there is no dislocation, and no skin compromise, what obvious clinical finding should have prompted us to manipulate first?
What condition can complicate this fracture after reduction +/- surgery
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An elderly patient attends with a history of a fall onto the chest. They have some chest wall tenderness on the right but are physiologically well. The following CXR was undertaken:  What abnormalities can you see?
What is the optimal management strategy for these? A 27 year old female presented to the ED complaining of sharp right sided chest pain which was pleuritic in nature. There was no history of trauma. She was not breathless. She was systemically well with no cough, sputum or haemoptysis. She had no signs or symptoms suggestive of PE and no VTE risk factors. She was not tachycardic or hypoxic and an ECG was completely normal. I was anticipating a normal CXR and was surprised by what I saw:  What is your suspected diagnosis based on the CXR?
....I would have been hauled over the coals if my boss ever saw this CT.  Actually I wouldn't, as back then a CT would require me getting my consultant out of bed, to get the radiology consultant out of bed, to warm up the scanner.....much more trouble than it was worth! But even ordering the XRay would have been considered poor practice.
So what is the diagnosis, and what has changed? So here we have the ECG of an elderly gent who'd had an MI 20 years ago, and an episode of palpitations 6 years ago for which he had been cardioverted - but he wasn't sure whether by drugs or DC. Otherwise pretty fit and well considering. He didn't have palpitations as such this time. He had a mild chest ache, which was improving. Obs and exam: HR160-170 regular, BP140/80, no evidence of failure and not short of breath.  So, what's your diagnosis? And how will you treat him?
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