injuries poisoning
Overview of Fractures
Key Points
Fractures that disrupt arterial supply and compartment syndrome threaten limb viability and may ultimately threaten life. Check for ligament, tendon, and muscle injuries as well as fractures; the presence of a fracture may limit or delay this evaluation. Examine the joints above and below the injured area. Consider referred pain, particularly if physical findings are normal in a joint that patients identify as painful (eg, knee pain in patients with a hip fracture). For many distal extremity injuries (eg, some injuries in toes 2 through 5, some ankle sprains), x-rays are not necessary to check for fractures because the presence of a fracture would not change treatment. Consider MRI (sometimes CT) when x-rays are normal but a fracture is strongly suspected clinically (eg, in an older person who has hip pain and cannot walk after a fall and initial x-rays are normal). Immediately treat serious associated injuries, splint unstable fractures, and, as soon as possible, treat pain and reduce certain angulated or displaced fractures. Immobilize unstable fractures immediately; use a cast or splint to immobilize all fractures that require reduction as soon as they are reduced. Treat fractures with PRICE (protection, rest, ice, compression, elevation). Provide patients with explicit, written instructions about cast care. When treating older patients, usually choose the method that results in the earliest mobilization. 