How to write the diagnosis report and treatment method of mild fracture of left fibula (that is, the kind with small crack at the front end)? Just write casually, thank you.

1 The first filming is to determine whether there is a fracture, and then state the details of the fracture.

X-ray signs of fractures are not complicated and generally easy to judge. When it is difficult to diagnose the fracture due to poor photo quality, improper photography posture or other overlapping tissue structures, the X-ray report should analyze the reasons in detail and put forward some possibilities of fracture and suggestions for further examination and observation. It is necessary to clarify the fracture details objectively and accurately in the report. The following problems should be paid attention to: (1) The fracture was found in the first X-ray examination, and the narrative part should avoid using conclusive terms that can only appear in the impression part to subjectively describe its image manifestations, such as fracture, compression fracture, pathological fracture and epiphyseal separation. (2) The fracture site should be accurately indicated according to X-ray anatomy. For example, the exact location of femoral neck fracture is in the lower, middle or base of femoral head; Whether the fracture of the bone end involves the joints and whether the linear fracture of the skull passes through the vascular groove, neural tube, sinus or middle ear should be explained as appropriate. It is a conceptual mistake to define epiphyseal fracture of children or epiphyseal fracture of long shaft as fracture of bone end. (3) There are many classification methods of fractures, and the commonly used ones under X-ray are as follows: ① According to the causes of fractures, they are divided into traumatic, fatigue and pathological fractures. ② According to the fracture time, it can be divided into fresh fracture and old fracture. ③ According to the degree of fracture and the shape of fracture line, it can be divided into: incomplete fracture, the most common ones are green branch fracture and cracked fracture; Complete fractures can be divided into transverse, oblique, spiral, crushing, avulsion, depression, incarceration and epiphysis separation. X-ray manifestations of different types of fractures have their own characteristics, so the description should highlight the main points and the conclusions should be different, not the same. If it is emphasized that some bones remain intact, it should be interpreted as incomplete fracture, which is different from complete fracture; Transparent fracture line is the basic X-ray sign of fresh fracture, and incarcerated or compressed fracture shows dense zone. It is obviously inappropriate to express epiphyseal separation with the negative shadow of cracks; If classified as compression fracture, it is inaccurate to judge the type of vertebral burst fracture; Vertebral compression secondary to senile osteoporosis is a pathological fracture. If there is no difference with traumatic fracture in the elderly, it will lead to treatment errors and even medical disputes. (4) Fracture displacement is one of the main contents of X-ray report. For the fracture without obvious dislocation, it should be explained according to the specific situation. If it is a complete fracture, it is necessary to make sure that the broken end is not displaced; Most skull fractures are incomplete longitudinal fractures or localized linear fractures, so it is unnecessary to emphasize that the fractures are not displaced. The green branch fracture only needs to know whether there is bending deformation. Complete fractures often have different degrees of displacement, and the direction and degree of displacement of distal fractures, smaller bone fragments and upper vertebrae should be accurately judged with proximal fractures, fracture shafts and lower vertebrae as fixed parts. The shortcomings and mistakes that are easy to appear in the report are as follows: (1) only describes the direction of crack displacement, but does not record the degree of displacement; (2) The description of comminuted fracture only focuses on the broken end, ignoring the displacement of bone fragments; (3) Embedding and overlapping of broken ends are confused, such as Smith fracture misdiagnosed as Colles fracture.

2. Determine reduction and fixation after fracture reduction.

Reduction and fixation of fracture are closely related to prognosis, and X-ray diagnosis report should make correct analysis and judgment. (1) After fracture reduction, X-ray diagnosis should focus on the re-evaluation of fracture and dislocation, the description should reflect the objective reality, and it is best to have reliable measurement data, and make a reasonable reply to the reduction according to the specific requirements of the operation. After the horizontal and vertical displacement is reduced, it has been reset to good alignment, and the alignment less than 1/2 is poor alignment; After reset, the angle disappears as a good alignment, and there is still an angle as a bad alignment. Anatomical reduction refers to the complete restoration of the fracture end to the normal anatomical position. If the fracture passes through the joint, anatomical reduction is needed to avoid affecting the joint function; Functional reduction means that the alignment of fracture is slightly poor, but the alignment is good, and the rotation and displacement are improved, which meets the requirements of functional recovery. For example, non-surgical reduction is usually based on functional reduction; Those who fail to meet the anatomical and functional requirements are poor reduction, and abnormal healing is bound to occur. It is worth noting that the fracture reduction standard is mainly measured by the alignment of the broken end and the alignment, but good alignment and alignment does not mean that the rotational dislocation has been corrected. Some fractures, such as wing fractures, avulsion fractures and comminuted fractures, can only explain their arrangement. (2) The X-ray manifestations of fracture fixation are more intuitive, which is an essential answer in the report. Accurately express fixtures and fixing methods, and avoid using nonstandard terms. The reliability of external fixation is evaluated by analyzing the position and direction of external fixation, and whether the broken end is displaced again or whether the residual dislocation is gradually reset during reexamination. According to the fixed position and direction of internal fixation, whether there is a fixture that is not conducive to fracture line healing and whether it causes new fractures or joint involvement, the overall effect of internal fixation can be judged.

3. Regular review, clear fracture healing and complications.

X-ray diagnostics introduces the fracture healing process and the manifestations of complications in detail, and will not repeat them. Here only points out the problems that are easy to appear in the report: (1) Follow-up observation of fracture healing process and complications. Naturally, the review time should be stated in the report, such as 4 weeks after the fracture, and the comparison with the original film should be analyzed, such as the fracture line is denser than before. (2) X-ray manifestations of fracture healing are closely related to its pathological process, and X-ray films mainly show the changes of fracture lines and the formation of callus. The healing of external callus is the main part of diaphyseal fracture, while the healing of internal callus is the main part of cancellous bone fracture. Normal bone healing can generally be divided into granulation tissue repair period, callus appearance period, callus connection period, callus maturity period and callus shaping period. Under ordinary X-ray, it is difficult to accurately grasp the repair of fracture granulation tissue, and the subsequent stages have obvious characteristics. The impression site should be diagnosed by stages of normal bone healing in order to meet the clinical wishes. If it is judged that the fracture healing has reached the stage of callus connection, the patient can remove the external fixation and gradually restore the function of the affected limb through functional exercise; If we take "fracture" or "old fracture" as the conclusion, it will lose its practical significance. Delayed healing, nonunion or abnormal healing are all abnormal bone healing, which should not be confused with normal bone healing, so as to strive for early detection and diagnosis. (3) The complications of fracture, such as bone infection, bone atrophy, ischemic necrosis, bone deformity, gas gangrene, traumatic arthritis or myositis ossificans, can be shown by X-ray, and the necessary analysis and judgment can not be ignored.

In a word, the X-ray diagnosis report of fracture is an important clinical file, which should be carefully written with a rigorous and scientific attitude.