What are the signs and symptoms of a fracture?

Signs and Symptoms of Fractures

The primary signs and symptoms of a fracture include obvious deformity, swelling, bruising, severe pain with movement, inability to move the affected extremity, and in some cases, visible protruding bone. 1

Common Signs and Symptoms

• Pain and Tenderness: Fractures typically cause significant pain, especially with movement or when pressure is applied to the injured area 1
• Swelling and Bruising (Ecchymosis): Soft tissue swelling and discoloration develop around the fracture site due to bleeding from damaged blood vessels 1
• Deformity: Obvious deformity may be present when bone fragments are displaced from their normal position 1
• Limited Mobility: Inability to move or bear weight on the affected extremity is common 1
• Crepitus: A grating sensation or sound may be felt or heard when the broken bone ends rub against each other 1

Specific Fracture Presentations

Long Bone Fractures

• Severe external or internal bleeding may occur, particularly with femur fractures 1
• Blue, purple, or pale extremities indicate poor perfusion, which is a limb-threatening emergency requiring immediate medical attention 1
• Inability to bear weight on the affected limb 1

Open Fractures

• Visible bone protruding through the skin 1
• Open wounds associated with fractures increase risk of contamination and infection 1
• May present with severe external bleeding requiring immediate control 1

Stress Fractures

• Gradual onset of localized pain that worsens with activity and improves with rest 1
• Subtle or absent deformity in early stages 1
• Localized tenderness over the fracture site 1
• Early radiographic findings may be nonspecific or nonexistent, making diagnosis challenging 1

Specific Anatomical Sites

Penile Fractures

• Penile swelling and ecchymosis (bruising) 1
• Cracking or snapping sound during the injury event 1
• Immediate detumescence (loss of erection) 1
• Penile pain and angulation 1

Testicular Rupture

• Scrotal ecchymosis and swelling 1
• Difficulty identifying the contours of the testicle on physical examination 1

Warning Signs Requiring Immediate Medical Attention

• Blue, purple, or pale extremities indicating compromised circulation 1
• Severe bleeding, especially with long bone or open fractures 1
• Inability to void or blood at the urethral meatus with pelvic or genital injuries 1
• Gross hematuria with suspected urethral injuries 1
• Signs of fat embolism syndrome (respiratory distress, altered mental status, petechial rash) following long bone fractures 2
• Signs of compartment syndrome (severe pain, pallor, paresthesia, pulselessness, paralysis) 2

Diagnostic Considerations

• History and physical examination are often sufficient to diagnose fractures, but imaging is typically required for confirmation 1
• Initial radiographs may be negative in stress fractures, with sensitivity of only 15-35% 1
• MRI is the most sensitive imaging modality for detecting occult fractures, especially stress fractures 1
• Ultrasound may be useful for certain fractures but has limitations and is operator-dependent 1

Early recognition of fracture signs and symptoms is crucial for appropriate management and to prevent complications such as malunion, nonunion, infection, and vascular compromise 3, 4.