Abstract
Aim: To test the knowledge of clinicians in orthopaedic clinics and emergency departments of the surface anatomical landmarks, that should be examined during assessment of foot and ankle injuries.
Methods: Specifically trained assessors observed 109 clinicians examining 6 anatomical landmarks on uninjured subjects. Each landmark was chosen for its relevance to assessment of foot and ankle injuries. The landmarks were the medial malleolus, lateral malleolus, fibula head, navicular, base of the 5th metatarsal and the anterior talofibular ligament (ATFL).
Results: 2 participants failed to identify a single landmark. Of 109 assessed, 27% correctly identified all 6 landmarks. The average correctly identified by each clinician was 4.1 (sd: 1.5 and range: 0–6). 107 correctly identified the lateral malleolus, the most consistently identified. The most poorly identified landmark was the ATFL, by 44%.
Discussion: The knowledge of surface anatomy of junior orthopaedic and emergency clinicians was found to be poor and only seems to significantly improve once higher specialty training is reached. Despite the potential for subjectivity and bias the authors believe the methodology is sufficient to demonstrate a lack of anatomical knowledge amongst clinicians. Poor anatomical knowledge leads to inaccurate examination. This can lead to incorrect diagnoses or even maltreatment of patients. Clinicians are becoming more reliant on unnecessary and expensive imaging investigations. They have neglected the basic art of physical examination based on sound knowledge of human anatomy. At present, the authors believe that the anatomical teaching in undergraduate medicine is inadequate.
Correspondence should be addressed to A.H.N. Robinson, BOX 37, Department of Orthopaedics, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge. CB2 0QQ, England.
