III. Exam

  1. Document neurovascular examination (and address deficits immediately)
    1. Perform on initial exam and repeat before and after any intervention
    2. Keep high index of suspicion for Compartment Syndrome
    3. Check Capillary Refill and distal pulses
    4. Check motor and Sensory Examination
  2. Evaluate skin over Fracture site
    1. Signs of open Fracture
    2. Signs of displaced Fracture (Skin Tenting)
    3. Clues suggesting Fracture (swelling, Ecchymosis, and point tenderness over Fracture site)
    4. Devitalized skin at risk of necrosis
  3. Evaluate joints, Muscles, ligaments, and tendons above and below the Fracture

IV. Indications: Referral to Orthopedics

  1. Emergent referral indications
    1. Fracture with neurologic deficit
    2. Fracture with vascular deficit
    3. Fracture with secondary Compartment Syndrome
    4. Open Fracture
    5. Severe crush or shearing injury resulting in skin devitalization
  2. Prompt referral indications
    1. Fracture site and type specific
    2. See High Risk Fractures

V. Management

  1. Initial management
    1. See specific Fractures for management
    2. Closed reduction under Procedural Sedation as needed
    3. See Fracture Splinting
    4. See RICE Therapy (RICE-M)
    5. Initial non-weight bearing for lower extremity Fractures
    6. NSAIDs
      1. Theoretical risk of delayed Fracture healing, but variable findings in human studies
      2. Typically safe for short-term use unless other contraindications (e.g. renal disease, peptic ulcer)
        1. Ibuprofen does not appear to significantly delay Fracture healing, especially in children age <11 years
        2. See NSAIDs for details
        3. (2017) Presc Lett 24(2): 9
        4. DePeter (2017) J Emerg Med 52(4): 426-32 +PMID:27751698 [PubMed]
        5. Choo (2021) Children 8(9): 821 [PubMed]
      3. However, use >3 days has been associated with an increased risk of nonunion or delayed union
        1. Ali (2020) Trauma 22(2): 94-111 [PubMed]
        2. Wheatley (2019) J Am Acad Orthop Surg 27(7): e330-36 [PubMed]
  2. Follow-up
    1. Re-evaluation in 5-7 days (sooner for High Risk Fractures)
    2. Repeat XRay and Casting at time of follow-up
  3. Patient precautions for immediate return
    1. Numb, cold, pale, immobile distal extremity
    2. Increasing pain out of proportion to what would be expected after Fracture

VI. Complications

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Related Studies

Ontology: Fracture (C0016658)

Definition (MEDLINEPLUS)

A fracture is a break, usually in a bone. If the broken bone punctures the skin, it is called an open or compound fracture. Fractures commonly happen because of car accidents, falls or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Overuse can cause stress fractures, which are very small cracks in the bone.

Symptoms of a fracture are

  • Out-of-place or misshapen limb or joint
  • Swelling, bruising or bleeding
  • Intense pain
  • Numbness and tingling
  • Limited mobility or inability to move a limb

You need to get medical care right away for any fracture. You may need to wear a cast or splint. Sometimes you need surgery to put in plates, pins or screws to keep the bone in place.

Definition (NCI_CTCAE) A finding of traumatic injury to the bone in which the continuity of the bone is broken.
Definition (NCI) A traumatic injury to the bone in which the continuity of the bone is broken.
Definition (CSP) breaks or rupture in bones or cartilages.
Definition (MSH) Breaks in bones.
Concepts Injury or Poisoning (T037)
MSH D050723
ICD9 E887, 829, 800-829.99
ICD10 T14.8
SnomedCT 269102008, 269323009, 157169007, 157255002, 208739000, 367344001, 217171007, 208744007, 307182008, 72704001, 125605004
LNC LP128687-3, MTHU040623
English Fractures, Fracture of unspecified bones, Fracture NOS, Fracture of bones NOS, Bone fracture, Fracture - lesion, fractures, bone fracture (diagnosis), fracture, bone fracture, Fracture bone, Fracture, cause NOS, Broken bones, Fractures, Bone [Disease/Finding], bone fractures, broken bones, bone fractured, fractured, fractured bone, broken bone, fracture of bone, bones fractured, Fracture NOS (disorder), Fracture: [of unspecified bones] or [NOS] (disorder), Fracture - lesion (disorder), Fracture: [of unspecified bones] or [NOS], Fracture of unspecified bones (disorder), Fracture, cause unspecified (disorder), Fracture (disorder), Fracture - lesion (morphologic abnormality), Fracture of bones NOS (disorder), Fracture, bone, FRACTURE(S), Fracture of Bone, Broken bone, Fracture of bone, Fracture (morphologic abnormality), Fracture of bone (disorder), bone; fracture, fracture; bone, Fracture, NOS, Fracture, FRACTURES, Fracture, cause unspecified, Broken Bones, Bone Fractures, Bone Fracture, Bone, Broken, Bones, Broken, Broken Bone, Fractures, Bone, Fracture, Bone, Fracture, cause unspecified (finding)
Italian Fratture, Frattura, Frattura ossea, Frattura NAS, Fratture di ossa non specificate, Rotture ossee, Fratture ossee
Dutch breuk van niet-gespecificeerde botten, botbreuk, breuk NAO, gebroken botten, bot; fractuur, fractuur; bot, breuken, breuk
French Fracture osseuse, Fracture d'os non précisés, Fracture SAI, Fracture, Fractures, Fractures de l'os, Fractures des os, Fractures osseuses, Os fracturés
German Fraktur NNB, Fraktur, Knochen, Fraktur unspezifischer Knochen, gebrochene Knochen, Frakturen, Fraktur, Frakturen, Knochen-, Gebrochene Knochen, Knochenbrüche
Portuguese Fractura de ossos NE, Fractura óssea, Fractura NE, Ossos partidos, Fracturas, Fractura, Fraturas de Ossos, Fraturas Ósseas
Spanish Fractura de huesos no especificados, Fractura ósea, Fractura NEOM, fractura, causa no especificada (hallazgo), Huesos rotos, fractura de hueso (trastorno), fractura ósea (trastorno), fractura ósea, fractura de hueso, fractura, SAI, fractura de huesos, SAI (trastorno), fractura de huesos no especificados (trastorno), fractura de huesos, SAI, fractura, SAI (trastorno), fractura, causa no especificada (trastorno), Fracture NOS, fractura, causa no especificada, fractura de huesos no especificados, fractura (anomalía morfológica), fractura, Fracturas, Fractura, Fracturas del Hueso, Fracturas Óseas
Japanese 骨折NOS, コッセツ, コッセツNOS, 骨折, タハツコッセツ, 多発骨折
Swedish Benbrott
Czech kosti - zlomeniny, fraktury kostí, Zlomenina kosti, Zlomenina NOS, Zlomenina, Zlomenina neurčených kostí, Zlomeniny, Zlomené kosti
Finnish Luunmurtumat
Polish Złamania kości
Hungarian Törés k.m.n., Törések, Törés, Csonttörés, Törött csontok, Nem meghatározott csontok törése
Norwegian Beinbrudd, Brudd i knokler, Frakturer i knokler, Knokkelbrudd, Skjelettfrakturer, Benbrudd