This monograph covers long bone fractures and includes fractures of the humerus, radius, ulna, femur, tibia, and fibula.
Acute fractures usually have a dramatic presentation, whereas stress fractures often present more subtly.
Acute fractures in older people often occur with relatively low-energy trauma, whereas in younger patients with previously healthy bone, they usually result from higher-energy trauma.
Associated injuries should be diligently searched for and neurovascular status should be evaluated.
At least two 90° orthogonal x-rays (e.g., anteroposterior and lateral) should be obtained, with inclusion of the joints proximal and distal to the site of suspected injury.
Proper immobilization, analgesia, and timely orthopedic referral as appropriate can greatly enhance patient comfort and ensure optimal outcome. Some nondisplaced long bone fractures can be treated conservatively, but consultation with an orthopedist is generally recommended.
Potential life-threatening complications include acute compartment syndrome, fat embolism, and hemorrhage.
A fracture is an abnormal disruption in the continuity of a bone and is often referred to as a broken bone. For the purposes of this monograph, long bones are defined as the humerus, radius, ulna, femur, tibia, and fibula. This monograph focuses on extra-articular fractures (i.e., fractures that do not extend into a joint).
History and exam
- direct trauma
- indirect trauma
- osteoporosis (insufficiency fractures)
- chronic renal failure
- diabetes mellitus
- bone tumor (pathologic fractures)
- age >70 years
- age <30 years
- male gender (acute fractures)
- female gender (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
Rutgers University Health Services
Clinical Assistant Professor of Internal Medicine and Family Medicine
Rutgers Robert Wood Johnson Medical School
PHC declares that he has no competing interests.
Trauma and Orthopaedic Surgery
University of Leeds
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
Department of Surgery
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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