Fractures often result from accidents. After sustaining an injury, how should one diagnose a suspected fracture? Below we outline fracture diagnosis methods and the importance of regular follow-up examinations.
I. Trauma History
While medical history inquiry covers many aspects, three key points should be emphasized for timely and accurate diagnosis: ① Injury circumstances (time, location, body part, posture, nature/direction/force of impact); ② Pain (specific location); ③ Functional impairment (mobility issues, sensory loss, urinary dysfunction, etc.).
II. Symptoms and Signs
The presence of any one of the following three signs—deformity, abnormal movement, or crepitus—confirms a fracture diagnosis. However, fractures may exist without these signs, such as greenstick fractures, impacted fractures, or hairline fractures.When soft tissue is interposed between fracture ends, crepitus or bone grating sensation may be absent. Abnormal movement and crepitus/bone grating sensation should only be noted during examination; deliberately manipulating the limb to induce these signs is prohibited to avoid exacerbating pain or causing sharp fracture ends to damage vessels, nerves, or other soft tissues, or dislodging/displacing impacted fracture fragments.
Pain, tenderness, swelling, ecchymosis, and functional impairment may be present in fresh fractures, as well as in dislocations or inflammatory soft tissue injuries. Some fractures, such as impacted or incomplete fractures, may present only with these clinical manifestations, necessitating X-ray examination for definitive diagnosis.
III. Radiographic Examination of Fractures
X-ray imaging should be routinely performed for suspected fractures. It can reveal incomplete fractures, deep fractures, intra-articular fractures, and small avulsion fractures that are difficult to detect clinically.Even in clinically obvious fractures, radiographic examination remains essential to determine fracture type and assess displacement of fracture fragments, providing critical guidance for treatment.
Fracture X-rays should generally include anteroposterior and lateral views encompassing the adjacent joint. Special views may be required as needed: e.g., anteroposterior and oblique views for metacarpal and metatarsal bones; lateral and axial views for the calcaneus; anteroposterior and oblique views for the scaphoid bone. When injury assessment is uncertain, X-rays of the corresponding contralateral site may be necessary for comparison.It is important to note that some minor hairline fractures may not show a clear fracture line on emergency X-rays. If clinical symptoms are significant, a follow-up X-ray should be taken two weeks after the injury. By this time, fracture line may become visible due to resorption of the fracture ends, as seen in scaphoid fractures.
The Importance of Regular Follow-up After Fractures
Following trauma, if a fracture is suspected—regardless of whether it was confirmed during the initial visit—regular follow-up is crucial. This is because:
(1) Some early signs of fracture (including subjective symptoms and radiographic findings) may be subtle. Fracture lines often become clearer several days later as fracture ends resorb.
(2) After immobilization with casts or splints, swelling at the fracture site gradually subsides over days. This relative loosening of external fixation may allow fracture displacement. Timely follow-up enables prompt detection and intervention.
(3) Fractures and their treatments inherently carry potential complications. Regular follow-ups facilitate early detection and management.
(4) All diagnostic methods involve multiple steps—machine operation, image acquisition, and interpretation—making it impossible to completely eliminate errors. This means a certain rate of false positives and false negatives exists. Relying solely on a single test to conclude the presence or absence of a fracture may not be sufficiently objective or accurate.
If a fracture is suspected, the following on-site first aid measures should be taken promptly:
(1) First assess the patient's general condition to determine the severity of local and systemic injuries, enabling timely life-saving intervention.
(3) For partially severed limbs, apply a tourniquet proximally to stop bleeding. During transport, release the tourniquet for 5 minutes every hour.
(4) Simple immobilization: Use readily available objects like sticks, poles, or boards to stabilize the fractured limb.If no materials are available, secure an upper limb fracture to the chest and a lower limb fracture to the unaffected side. Immobilization devices should generally extend beyond both joints.For spinal fractures, three people should stand on the same side, lift the patient level with hands, and place them flat on a board to prevent spinal twisting that could cause paraplegia. For cervical spine fractures, one person should gently traction the head while placing it flat on the stretcher. Maintain this traction position during transport to prevent cervical spine movement from turning the patient.