Resident's Case Problem: Identification of a Fibular Fracture in an Intercollegiate Football Player in a Physical Therapy Setting

Donald Lee Goss, Josef H. Moore, Darryl B. Thomas, Thomas M. DeBerardino

DOI: 10.2519/jospt.2004.1310

Injuries to the ankle or foot are some of the most common orthopaedic complaints seen in primary care and sports medicine settings, accounting for 5% to 10% of all visits. Physical therapists working in a military setting are frequently the first credentialed providers to evaluate and diagnose patients with musculoskeletal complaints or orthopaedic trauma, using their privileges to order radiographs, bone scans, and electromyographical/nerve conduction study examinations. Because the presenting symptoms of sprains and fractures are often similar, it is imperative that physical therapists are competent and comfortable with their role of evaluating acute traumatic injuries without a physician referral. The validity of physical therapists managing patients with acute musculoskeletal injuries, without physician referral, has been previously established. This important role has enabled US Army orthopaedic surgeons to focus their practice on more complicated trauma or surgical cases. As direct access becomes more prevalent in the civilian profession of physical therapy, it becomes increasingly important that the physical therapist, as the first credentialed provider evaluating the patient, is proficient in distinguishing between ankle sprains and fractures. Even in the absence of direct access, physical therapists should still be able to determine when radiographs are appropriate in the event of a misdiagnosis and referral for an ankle sprain. The Ottawa Ankle Rules and the Buffalo modification are effective clinical decision rules to assist therapists in ruling out a fracture or determining whether radiographs are necessary for acute ankle injuries. We chose to report this case as example of how physical therapists can effectively apply these rules while serving in a direct-access role for the benefit of patients.

J Orthop Sports Phys Ther. 2004;34(4):182-186. doi:10.2519/jospt.2004.1310

Key Words: sprains, fractures, Ottawa Ankle Rules, Buffalo modification, direct-access

This case offers an example of how physical therapists can effectively apply the Ottawa Ankle Rules and the buffalo modification while serving in a direct-access role for the benefit of patients.

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