Significant pain that has not at least somewhat improved after a couple hours of ice, elevation and anti-inflammatory medication.Any obvious abnormal angling of the limb (arm, finger, leg or toe).Any open fracture, which is a laceration or other opening of the skin at the site of injury, especially if any bone is visible - this is an emergency!.Things that require immediate evaluation: No one knows your child or the specific circumstances better than you do! So when should you bring your child in for a suspected fracture? Here are some general guidelines but ALWAYS feel free to call your physician or be seen if you are ever in doubt. Broken bones don’t like vibration! But again, this is just an indicator, it is not 100% accurate! If it causes increased pain, it is more likely that the bone is broken. Interestingly enough, one helpful indicator of a broken bone is a tuning fork! Simply place a vibrating tuning fork, handle down, on the injury.I’m sure you’re catching on to this now, False! While swelling and eccymosis are good indicators that a bone may be broken, they are not necessary – some bones may break with little to no swelling or bruising. If it isn’t swollen and black and blue, it isn’t broken.False! We see many tibia fractures that the patient has been walking on prior to coming in for evaluation. If the child can walk on it, it isn’t broken.False! Most patients still have some ability to move the injured area. If the child can bend it, it isn’t broken.There are many ways people try to determine if a bone is broken. As it sounds, a bone contusion is a bruise to the bone itself and may take as long to heal, or sometimes longer, than a fracture! Bone contusions are difficult to detect on X-ray and may need further imaging. A strong, blunt force to the bone may result in a bone contusion rather than a fracture. Stress fractures may be difficult to initially identify with an X-ray as they can be very subtle. However, too much stress on a bone for a prolonged period of time can cause injuries such as stress fractures. This is what we see with weight bearing exercises like walking and running. Some stress or force on bones is healthy as it causes the bone to strengthen. A spectrum exists with regard to force applied to bone. A bone FRACTURE and a BROKEN bone mean the same thing. The answer to this question is not always as straightforward as we would like! First, let’s review some terminology.
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