Commonly missed orthopaedic injuries.

CROSSING the road is safe enough-but only for those who always take care. The child who relaxes his vigilance is heading for disaster. The Casualty Officer is in a like condition. Most bone injuries are obvious even to the patient and are easily confirmed by the doctor; but without constant care errors are inevitable and, as with crossing the road, the penalty is high. The object of this short article is to mark the Accident Black Spots: those areas where routine methods of examination must be amplified by a high index of suspicion. But first a few guiding principles-The Casualty Officer's Highway Code. Of course a careful history and thorough clinical examination are essential in every case. This statement, constantly made, is true but full of cliches and, therefore, ignored. The history really does matter, and the doctor must listen patiently as if he had all the time in the world. And when he begins his clinical examination it is a mistake to pounce on the injured part; assessment of the general condition needs to come first; and the local examination which follows must be gentle, systematic and meticulous. Finally X-rays may be needed for diagnostic precision or medico-legal protection. With reasonable care and a strict routine all the injuries described below can be correctly diagnosed-and yet the long list of insurance claims testifies to the frequency with which they are missed. The list is not completeit never could be-but it contains the most persistent offenders.