When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Long bone fracture

Última revisão: 13 Feb 2025
Última atualização: 07 Mar 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • pain
  • soft tissue swelling
  • ecchymosis
  • expanding hematoma
  • impaired limb function
  • inability to bear weight
  • point tenderness
  • deformity
  • guarding
  • wound overlying or near site of injury
  • signs of vascular injury
  • signs of acute compartment syndrome
  • hypotension/hypovolemic shock
Detalhes completos

Outros fatores diagnósticos

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

Fatores de risco

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

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • x-ray limb
  • CBC, blood typing, and cross-matching (major trauma)
Detalhes completos

Investigações a serem consideradas

  • MRI of area of interest without IV contrast
  • noncontrast CT of fracture
  • whole body bone scan with SPECT or SPECT/CT area of interest
  • compartment pressure testing
  • Doppler pressure (ankle/brachial systolic pressure index)
  • ultrasound duplex scanning
  • CT angiogram
  • angiography
  • dual-energy x-ray absorptiometry bone density scan
  • whole-body CT
Detalhes completos

Algoritmo de tratamento

Inicial

involved in high-energy trauma

AGUDA

distal humeral shaft: nonstress

midshaft humeral: nonstress

proximal humeral shaft: nonstress

radial or ulnar shaft: nonstress

upper limb stress fractures

femoral shaft: nonstress

tibia or fibula shaft: nonstress

femoral stress fractures

fibular or posteromedial tibial stress fractures

Colaboradores

Autores

Philip H. Cohen, MD

Clinical Associate Professor of Medicine

UCLA David Geffen School of Medicine

Los Angeles

CA

Declarações

PHC has given lectures for MCE Conferences, a medical education company, and received a stipend/free hotel room during the conference. MCE Conferences accepts no funding from pharmaceutical companies or other outside agencies, and PHC declares that the lectures have no impact on the topic.

Revisores

Robert D. Golden, MD

Chief, Orthopaedic Surgery

MedStar Washington Hospital Center

Regional Chief

Orthopaedic Trauma Surgery

MedStar Orthopaedic Institute

Washington

DC

Declarações

RDG declares that he has no competing interests.

  • Long bone fracture images
  • Diagnósticos diferenciais

    • Contusion
    • Anterior glenohumeral dislocation
    • Rotator cuff injury
    Mais Diagnósticos diferenciais
  • Diretrizes

    • ACR appropriateness criteria: stress (fatigue-insufficiency) fracture including sacrum excluding other vertebrae
    • Fractures (complex): assessment and management
    Mais Diretrizes
  • padlock-lockedConectar-se ou assinar para acessar todo o BMJ Best Practice

O uso deste conteúdo está sujeito ao nosso aviso legal