Fracture

History: Fractures are either the result of a traumatic event or repeated stress to an area of the body. In cases of trauma related fractures, individuals may describe an injury, such as a fall or an object falling on them. In cases of stress fractures, the individual may not remember a specific injury, but there is usually a history of recent activity to which the individual is not accustomed. Individuals may have obviously misshapen (deformed) bones, swelling, pain and/or lack of feeling (decreased sensation) near the area of a fracture. The ability to move and use an injured body part does not exclude the possibility of a fracture. It is important to obtain a thorough history, including questioning about previous injuries.

Physical exam: 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) is usually 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 must include the joint above and below the injury site. Subtle (occult) fractures may not be visible on x-ray exam for up to 2 weeks after they occur. CT scans and/or MRI may be needed to further define the fracture and its effect on surrounding joints. EMG and angiography may be required to evaluate damage to nerves and vessels. A bone scan may show a subtle fracture, such as a stress fracture not easily recognized on plain x-rays.