Long bone fracture

Last reviewed: 28 Aug 2023
Last updated: 15 Dec 2022



History and exam

Key diagnostic factors

  • 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
More key diagnostic factors

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
Other diagnostic factors

Risk factors

  • 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 (stress 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
More risk factors

Diagnostic investigations

1st investigations to order

  • x-ray limb
  • CBC, blood typing, and cross-matching (major trauma)
More 1st investigations to order

Investigations to consider

  • noncontrast CT of fracture
  • triple-phase bone scan
  • MRI limb
  • 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
More investigations to consider

Treatment algorithm


involved in high-energy trauma


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



Philip H. Cohen, MD

Clinical Associate Professor of Medicine

UCLA David Geffen School of Medicine

Los Angeles



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.

Robert D. Golden, MD

Chief, Orthopaedic Surgery

MedStar Washington Hospital Center

Regional Chief

Orthopaedic Trauma Surgery

MedStar Orthopaedic Institute




RDG declares that he has no competing interests.

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