Respond to post with 1 reference and ask a question at the end.
As a nurse practitioner how would you evaluate a patient with a possible sprain or fracture?
Most foot fractures involve metatarsal shaft fractures that are characterized by some amount of focal pain, swelling, and difficulty bearing weight (Bica et al., 2016). Therefore, upon physical examination, I would check for ecchymosis, swelling, point tenderness upon palpation, and then I would perform a slow maneuver called a positive metatarsal loading test, by placing an axial load onto the head of the potential fractured metatarsal, and then seeing if this elicits a point tenderness and pain at the fracture site (Hatch et al., 2007). If severe pain is noted, then this would indicate an acute fracture and not a soft tissue injury (Bica et al., 2016).If pain is not elicited or reported by the patient after this maneuver is performed, the patient would then be likely to have a soft tissue injury such as a sprain instead. A sprain is characterized by ligament injury and ligament rupture, depending on the severity of the sprain (Ivins, 2006). Ankle sprains are the most common, and typically produce pain and limited range of motion. After 3-5 days of initial injury, reexamination and certain tests can be conducted to help accurately diagnose the injury since the swelling and pain should subside by then. Three tests that can be used to determine the type of ankle sprain is an anterior drawer test, crossed-leg test, and the inversion stress test or talar tilt (Ivins, 2006). If any of these tests produce positive findings, then it would be determined that a sprain has occurred rather than a fracture.
References
Bica, D., Sprouse, R. A., & Armen, J. (2016, February 1). Diagnosis and management of common foot fractures. American Family Physician. https://www.aafp.org/pubs/afp/issues/2016/0201/p183.html
Hatch, R. L., Alsobrook, J. A., & Clugston, J. R. (2007, September 15). Diagnosis and management of metatarsal fractures. American Family Physician. https://www.aafp.org/pubs/afp/issues/2007/0915/p817.html
Ivins D. (2006). Acute ankle sprain: an update. American family physician, 74(10), 1714–1720.
