History Taking in MSK Trauma

Overview

Prof. Mamoun Kremli
Dr. Tarif Al Akhras

History Taking

Key Components

• Patient’s story / or companion’s
• Doctor/student reconstructs the history
  • Open-ended questions
    • How did it happen?
  • Leading questions
    • Were you able to stand/walk after the injury?
    • What increases the pain?
    • Did you vomit?

History Structure

Following the History Theme

• Patient Demographic
• Chief Complaint
• History of Presenting Complaint
• Past medical/surgical history
• Medication/allergy history
• Family history
• Social history
• Diet
• Activity
• Systemic review Relate to function

Trauma History

Detailed History of Injury

• Details of injury:

  • Mechanism of injury. High Vs. Low velocity Open Vs. Closed
  • Date, time, type, force, method of impact, direction,
  • Consciousness level.
  • Other injuries. Life/ Limb threatening
  • Other medical problems

• Details of fracture:

  • Pain. Swelling, Deformity, movement of injured part
  • Wounds/ bleeding.
  • Anti-Tetanus status (if skin breached)
  • Other major injuries

• Relate to function

• Details of initial management

Additional Considerations

• For all cases, ask about

  • Progression
  • Previous investigations
  • Previous treatment

• Careful:

  • Fractures are not always at the site of impact
  • Some fractures do not need severe force

• From Trauma history, you should be able to differentiate

  • Low energy from High energy trauma

Low Energy Trauma

Key Questions

• When, Where, How?
• AMPLE History (acute):
  • Allergy,
  • Medication,
  • Past Medical & Surgical History,
  • Last Meal,
  • Event (How? Or Mechanism of injury)

All covered by our history, except: Last meal

High Energy Trauma

Road Traffic Accident (RTA)

• Low energy Qs,
• Driver / Passenger / Pedestrian
• Seat belted / non-belted
• Speed and location of impact
• Position of the patient and the limb at impact
• Severity of crash
  • Need to use the “Jaws of Life”
• Type:
  • Head-on collision. Side impact. Car turn-over

Fall from Height

• Low injury Qs
• How many levels
• Position of the patient and the limb at impact
• Missed injuries
  • Combination injuries

Pathological Fractures

Considerations

• Minor trauma (e.g., slipped at home) indicates a pathological fracture
  • In elderly:
    • Osteoporosis: Diet, sun exposure, risk factors of osteoporosis
    • Secondary metastasis: history of known malignancy, systematic review carefully looking for unknown primary
  • In younger: look for cause of weak bone
    • Osteomalacia, hyperparathyroid, bone disease
  • In very young: local pathology: cyst, infection

Trauma Case Histories

Case 1: Knee Injury

• A 25-year-old injured his knee while playing football
  • Mechanism of injury
  • Swelling:
    • Immediate: hemarthrosis: Cruciate / fracture
    • Later: effusion: meniscal injury
  • History of locking / giving way

Case 2: Motor Vehicle Accident

• A 32-year-old female was brought to the emergency room after a motor vehicle accident

Case 3: Fall from Scaffold

• A 45-year-old man was seen in the emergency room after falling from a scaffold in a building site

Case 4: Hip Pain After Fall

• A 65-year-old lady presented to the emergency room with pain in right hip after falling at home