Summary
Definition
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 site of injury
- signs of ischemic limb
- hypotension/hypovolemic 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 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
Diagnostic investigations
1st investigations to order
- x-ray limb
- CBC, blood typing, and cross-matching (major trauma)
Investigations to consider
- noncontrast CT of fracture
- triple-phase bone scan (TPBS)
- MRI limb
- compartment pressure testing
- Doppler pressure (ankle/brachial systolic pressure index [ABI])
- U/S duplex scanning
- angiography
- DXA bone density scan
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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