Successful Treatment Hinges on an Accurate Diagnosis

All of us will agree that in most cases a careful historical interview and clinical examination will lead us to the correct diagnosis. But circumstances do not always fall neatly into place. Sometimes, historical information is inaccurate, clinical findings are obscured by concomitant physiological or pathological conditions, or technological limitations obscure the correct diagnosis. Misdiagnosis is also more likely in cases involving a rare disease or an unusual condition, one that doesn't fit established guidelines and previously understood standards. Sometimes the examining surgeon simply fails to pick up on an important clue. None of us is the perfect diagnostician all of the time, although we owe it to our patients to try to peg the diagnosis the first time, every time. Sometimes, moreover, we manage to successfully treat a patient even though our diagnosis may not be completely accurate. And, as described in the interesting case report dealing with a Maisonneuve fracture, by Charopoulos et al and published herein, the importance of reappraisal of the clinical situation, including taking a closer look at the radiographs, when clinical symptoms persist or change cannot be overstated. I think that we can all agree that if our patient is not progressing satisfactorily in a reasonable period of time, then either our treatment is inadequate or our diagnosis is wrong. In such cases, it usually pays to reassess the patient and, perhaps, to get another surgeon's opinion. We have all been in the clinical scenario where the precise diagnosis eludes us, and for this reason I hope that the Maisonneuve fracture case report that we publish in this issue piques our readers' interest.