Clinical features of fractures

The history of the injury provides information on the likely mechanism of injury.

The past history will identify previous injury which could confuse interpretation of the radiograph, or predisposing factors such as osteoporosis.

Frequently, there is bruising, swelling and physical deformity. Establish early whether the injury is an open fracture.

Abnormal movement and loss of function are common. The injury is often painful although this is less of a feature in skull and vertebral fractures. In the limb, pain may be elicited by bending or compressing the limb. Crepitus can often be heard between the bone ends.

Beware of mistakes easily made:

• the fracture may not always be at the site of impact - a blow to the knee may fracture any of the patella, femur or acetabulum
• undisplaced fractures do not cause deformity
• impacted fractures do not cause abnormal movement or crepitus
• bruising and swelling may not occur immediately
• the unconscious patient cannot inform of pain