Last reviewed: October 2017
Last updated: March  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • pain
  • soft tissue swelling
  • ecchymosis
  • expanding haematoma
  • impaired limb function
  • inability to bear weight
  • point tenderness
  • deformity
  • guarding
  • wound overlying site of injury
  • signs of ischaemic limb
  • hypotension/hypovolaemic shock

Other diagnostic factors

  • altered nerve sensation
  • impaired motor function
  • bony crepitus
  • callus
  • reproduction of symptoms in stress fractures of the neck or shaft of the femur

Risk factors

  • direct trauma
  • indirect trauma
  • osteoporosis (insufficiency fractures)
  • chronic renal failure
  • diabetes mellitus
  • bone tumour (pathological fractures)
  • age >70 years
  • age <30 years
  • male sex (acute fractures)
  • female sex (stress and insufficiency fractures)
  • prolonged corticosteroid use (insufficiency fractures)
  • low BMI (insufficiency fractures)
  • hx of recent fall (insufficiency fractures)
  • prior fracture (insufficiency fractures)
  • seizures (proximal humerus fracture)
  • long-term bisphosphonate use

Diagnostic investigations

1st investigations to order

  • x-ray limb
  • FBC, blood typing, and cross-matching (major trauma)
Full details

Investigations to consider

  • non-contrast CT of fracture
  • triple-phase bone scan (TPBS)
  • MRI limb
  • compartment pressure testing
  • Doppler pressure (ankle/brachial systolic pressure index [ABI])
  • ultrasound duplex scanning
  • angiography
  • DXA bone density scan
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Attending Physician

Rutgers University Health Services

Clinical Assistant Professor of Internal Medicine and Family Medicine

Rutgers Robert Wood Johnson Medical School

Piscataway

NJ

Disclosures

PHC declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor

Trauma and Orthopaedic Surgery

University of Leeds

Leeds

UK

Disclosures

PG is an editor for Chief Injury. He has received research grant support from Depuy-Synthes, Biomet, and Pfizer, and has received honoraria from Olympus Biotech, Medtronic, Pfizer, Biomet, and AO Foundation.

Orthopaedic Trauma Surgeon

Assistant Professor

Department of Surgery

McMaster University

Hamilton

ON

Disclosures

BP has received speaking fees from AO North America, OTC, Stryker, and Smith & Nephew. BP has received consult fees from Stryker Canada.

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