From the Guidelines
The workup for an overstretched leg fall should begin with a thorough physical examination to assess for pain, swelling, deformity, and neurovascular status, as well as initial imaging with plain radiographs (X-rays) to rule out fractures 1.
Key Components of the Workup
- Initial imaging: plain radiographs (X-rays) to rule out fractures
- Soft tissue evaluation: MRI if suspected injury to ligaments, tendons, or muscles
- Vascular assessment: Doppler ultrasound or CT angiogram for suspected vascular compromise
- Laboratory tests: complete blood count, basic metabolic panel, and inflammatory markers like C-reactive protein if infection or systemic response is suspected
- Pain management: acetaminophen (500-1000mg every 6 hours) or NSAIDs like ibuprofen (400-600mg every 6-8 hours) if not contraindicated
- Implementation of the RICE protocol (Rest, Ice, Compression, Elevation) immediately
- Physical therapy evaluation once acute pain subsides, typically within 3-7 days
Considerations for Specific Patient Populations
- Geriatric patients: consider risk factors for falls, such as history of falls, mobility problems, and poor performance on the timed Get-Up-and-Go test 1
- Patients with diabetes: consider risk factors for foot ulcers and the need for offloading devices or custom-made footwear 1
- Patients with functional neurological disorders: consider occupational therapy interventions to promote normal movement patterns and reduce symptoms 1
Importance of Individualized Care
The workup and treatment plan should be tailored to the individual patient's needs, taking into account the severity of the injury, patient age, and comorbidities. Regular reassessment and adjustment of the treatment plan as needed are crucial to ensure optimal outcomes.
From the Research
Workup for Overstretched Leg Fall
The workup for an overstretched leg fall involves a thorough evaluation to determine the extent of the injury.
- A comprehensive physical examination should be performed, including examination of the injury, the kinetic chain, and core 2.
- A thorough history should be taken to understand the mechanism of injury and any previous injuries or conditions that may be relevant 2, 3.
- Radiological assessment, including X-rays and computed tomography (CT) scans, may be necessary to evaluate the extent of the injury and detect any fractures or other internal injuries 4, 5.
- Blood investigations may also be necessary to rule out any underlying conditions that may have contributed to the injury 6.
- The evaluation should also consider the possibility of non-accidental injury, particularly in cases where the mechanism of injury is unclear or suspicious 6.
Importance of Thorough Workup
A thorough workup is essential to avoid misdiagnosis or underdiagnosis of the injury.
- Early diagnosis and timely operative management can improve outcomes and reduce the risk of further injury 5.
- A comprehensive evaluation can also help identify any functional deficiencies in core strength and balance that may have contributed to the injury, allowing for targeted rehabilitation and prevention of further injury 2.
- In cases where the injury is severe, a thorough workup can help identify any limb-threatening emergencies that require prompt referral to a hospital 3.