Bone fracture. Whether it’s the amount of time away from sport and work or the potential for ongoing issues, fractures are nasty injuries. If a fracture has occured, it’s crucial to seek medical advice as soon as possible. But spotting a fracture isn’t as simple as it sounds. Some are easy to spot (a foot facing backwards tends to be a giveaway) but others can be more subtle, especially in young children. So here’s a guide to identifying a potential fracture of an arm/hand or leg/foot bone. Of course, if you’re concerned, or if your fracture involves head/neck, spine, ribs or pelvis, regardless of the information below, you should seek medical advice from your nearest health practitioner.
How to assess the injury
- Compare the limb to the other limb
- Always check and monitor colour, temperature and pulse in the hand or foot of the injured limb
- Quietly observe behaviour and willingness to use the limb
- Reassess the injury after easing the initial pain with acute injury care
- Deformity: angulation of long bones and altered joint angles
- Pain: while many injures can be painful, fractures tend to cause pain without movement or weight/pressure on the limb
- Shortening of limb: compare the sides in a resting, natural position
- Loss of function distally: a fractured arm bone is often associated with loss of function in the hand, such as inability to grip firmly
- Unwillingness to move and being withdrawn in young children: while they won’t often directly complain, children can withdraw from activity or be unwilling to use the limb in play or daily care tasks
Ottawa Rules for knee and ankle.
These tests were developed for use in Emergency Departments and indicate the need for X-Ray if even one of these tests failed. While they are quite accurate at screening for fractures in specific locations around the ankle and knee, they will not exclude all fractures or other fractures around the knee and ankle.
- Functional tests: ability to walk four steps at the time of injury and on assessment (regardless of limping or pain) for knee and ankle/foot fractures, ability to bend knee past 90 degrees (only for knee fractures, obviously).
- Palpation: pain in specific locations such as on the back edge of the ankle bones or isolated pain in areas such as on the kneecap may indicate the need for X-Ray. For more information on the exact locations to palpate, see Ankle palpation rules and Knee palpation rules (note: knee palpation must be ISOLATED tenderness)
These features may indicate damage to blood vessels and/or nerves and medical care should be sought urgently.
- Loss of sensation distally
- Colour change distally
- Loss of pulse distal to injury
Course of action
- If any of the features listed under Concerning Features is detected, immediately go to your local hospital or call an ambulance, if you do not have transport or no medical services are nearby.
- If any of the Key Features are present or you have a positive Ottawa test, head to your local emergency department or your local doctor/medical centre
- If you aren’t sure or you think it’s unlikely to be a fracture, there may still be a nasty soft tissue injury or subtle fracture present. Head for your local health professional to confirm the diagnosis and offer advice on management.