Extremity fractures
Extremity fractures are diagnosed by focal bony tenderness, deformity, or inability to bear weight/load confirmed on radiograph, and are triaged first for life- and limb-threatening features (hemorrhage, open injury, vascular compromise, compartment syndrome) before definitive fixation decisions. Open fractures need immediate antibiotics and operative debridement, and unstable or displaced patterns need surgical fixation, while stable nondisplaced fractures are managed with reduction and immobilization.
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What this article covers
- Overview
Fractures span a spectrum from stable to limb- and life-threatening: an extremity fracture is a break in the continuity of a long bone of the arm or leg, ranging from a stable nondisplaced fracture…
- Epidemiology
Extremely common across all ages: among the most frequent reasons for emergency department and orthopedic evaluation, from falls, motor vehicle collisions, sports injuries, and direct trauma.
- Risk factors
High-energy trauma mechanism: motor vehicle collisions, falls from height, and direct blunt or penetrating trauma dominate in younger patients.
- Pathophysiology
Fracture pattern reflects the mechanism of injury: loading force, direction, and compressive stress determine whether the fracture is transverse, spiral (twisting), comminuted (more than two…
- Clinical features
Focal bony tenderness with deformity, swelling, or inability to bear load is the presentation that triggers imaging: suspected clinically with focal tenderness over a bone, swelling, ecchymosis…
- Differential diagnosis
Ankle or ligamentous sprain: discriminator is the ability to bear weight (even if painful) and a normal radiograph obtained per the Ottawa ankle rules.
- Diagnosis
Diagnosis is confirmed by radiograph demonstrating cortical discontinuity, with open/closed and displaced/nondisplaced status determining management: confirmed radiographically (cortical break, with…
- Management
First step, primary survey and control of life-threatening hemorrhage: in a femur, pelvic, or multi-extremity fracture, assess for hemorrhagic shock first; apply firm manual compression, a tourniquet…
- Complications
Hemorrhagic shock: roughly 40% of femur fractures bleed, poorly tolerated in elderly patients with limited cardiac reserve.
- Prognosis
Most closed, nondisplaced fractures heal well with immobilization alone, without long-term deficit, over weeks to a few months depending on the bone and patient age.
- Prevention
Osteoporosis screening and treatment in older adults: screen women age 65 and older (and younger postmenopausal women with risk factors) with DEXA bone density testing, treat when the T-score is -2.5 or lower or after a fragility fracture.
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