Host: Some of the kids get injuries and you look at their hand, actually the kid’s finger is fractured, their wrist is fractured, what would you tell someone that you know this is not just a simple soft tissue injury and more likely a fracture, what would you look for, tell the parents to look for?
Guest: The problem in children is that when they have broken their bones they heal very fast which means we can't have a delay in the diagnosis of broken bones, especially when that is displaced. And so I always tell the mother, get an X-ray whether that is in the emergency room or a neighborhood X-ray place or come to my office, wherever they can get an X-ray. I tell them to get an X-ray just to rule out a bone injury, so what happens, there are times when a bone is broken and the mother thinks this is just a soft tissue injury and they wait for ten days and then come to the office, the bone is partially healed and in a bad position and if this happens to a joint, if the fracture is involving the joint that is a bad situation to fix.
Host: So in other words if it is -- except for a little tenderness, it probably more likely than not get an X-ray, isn’t that?
Guest: It is very hard for the mothers to really make a judgment because some kids are tolerant to pain and some are not and some kids don't even complain of pain for two-three days even if they have been injured and --
Host: Is the term pinpoint tenderness help at all?
Guest: Yes, a pinpoint tenderness is a good thing if you can palpate the bone and if the bone is tender, definitely get an X-ray.
Host: So in other words if you feel the bone, you go up and down and one area seems to have more pain than all the other areas that is like you have got a problem to prove in other words?
Guest: That is the reflect.
Host: Okay, but if you see a kid may be hit with a basketball and the fingers may be a little bit swollen and you can move it, it seems okay. It doesn't mean you don't have a fracture it is a little less likely, is that right?
Guest: It is less likely if the child does some other -- I can move my finger but it hurts. If they can move the fingers but it hurts they can wait for tomorrow to get the X-rays, but if the child can not move the joints and the finger is swollen, I would almost always recommend the mother to get an X-ray.
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