History: Fractures are either the result of a traumatic event or repeated stress to a bone in the body. In cases of trauma-related fractures, individuals may describe an injury, such as a fall or an object falling on or striking them. The individual may report having heard a cracking sound at the moment of fracture, and may be unable to bear weight on the affected limb if the fracture occurred in the lower extremity. However, the ability to move and use an injured body part does not exclude the possibility of a fracture. In cases of stress fractures, the individual may not remember a specific injury, but there usually is a history of recent activity to which the individual is not accustomed or a repeated activity that stresses a bone (e.g., distance running). It is important to obtain a thorough history, including medication use and previous injuries.
Physical exam: Individuals may have obviously misshapen (deformed) bones, swelling, pain and/or lack of feeling (decreased sensation) near the area of a fracture. Visual examination may be diagnostic in cases where the deformity is obvious. Touching the area (palpation) reveals pain or tenderness over the area. There may be decreased sensation beyond the fracture. Swelling and bruising (ecchymosis) usually is present. Joint looseness (laxity) and changes in range of motion may be evident.
Tests: Plain x-rays are used to determine the presence of a fracture, the severity of the fracture, and the position of the fragments. X-rays generally include the joint above and below the injury site. Subtle (occult) fractures and some stress fractures may not be visible on x-ray exam for up to 2 weeks after they occur. Suspected but hidden fractures (occult fractures) of the scaphoid bone in the wrist are undetectable on plain x-ray 60% of the time (Brydie 296). CT scans and/or MRI may be needed to further define the fracture and its effect on surrounding joints. Electromyogram and angiography may be required to evaluate damage to nerves and blood vessels. A bone scan may show a subtle fracture, such as a stress fracture that is not easily recognized on plain x-rays.
Source: Medical Disability Advisor