Orthopedics & Emergency Medicine & Family Medicine
Fracture
A fracture is an interruption of the continuity of a bone, either total or partial, that occurs when a mechanical force exceeds the resistance of bone tissue. It is one of the most common injuries in medicine—an estimated fracture occurs every 3 seconds worldwide—and is a major cause of emergency room visits, hospitalization, and long-term morbidity, particularly in elderly patients with osteoporosis. Bone tissue is a living tissue, continuously remodeled by osteoblasts (formation) and osteoclasts (resorption), and possesses a remarkable healing capacity: bone healing occurs in four phases—the inflammatory phase (days 0–7: fracture hematoma + cell recruitment), the soft callus phase (days 7–21: fibrocartilaginous callus), the hard callus phase (days 21–60: callus ossification), and the remodeling phase (months to years: mineralization + restoration of cortical architecture). The strength and speed of healing depend on the patient's age (children heal faster), the fracture location, the fracture pattern (spiral or oblique fractures heal faster than transverse ones), residual displacement, local vascularization, nutritional status (calcium, vitamin D, proteins), smoking (significantly delays healing), and the presence of osteoporosis or underlying bone disease. Fracture management is based on three fundamental principles: reduction (restoring fragments to proper alignment), containment (maintaining reduction during healing), and rehabilitation (restoring function).
Classification, diagnosis, and initial assessment
- Fracture Classification — Essential Clinical Terminology Based on skin integrity: Closed fracture (intact skin – no communication with the outside) vs. Open fracture (communication between the fracture site and the outside via a skin wound) – Gustilo-Anderson classification for open fractures: Grade I (wound 10 cm or massive contamination): IIIa (adequate bone coverage) + IIIb (skin and soft tissue loss + exposed bone) + IIIc (associated vascular injury requiring repair) – an open fracture is a surgical emergency; Based on fracture line: Transverse (perpendicular to the long axis of the bone – direct trauma) + Oblique (angular force) + Spiral or helical (twisting – typical of rotational fractures) + Comminuted (multiple fragments – high-energy trauma) + Impacted or compressed (spongy bone – vertebrae + talus + tibial plateau) + Greenstick (incomplete fracture in children – one side of the cortex intact) + Buckle / Torus (barrel-shaped deformation of the cortex without rupture – child); Based on displacement: Non-displaced (al) + Displaced (varus/valgus + overriding + angulation + rotation) – displacement influences treatment choice; Based on etiology: Traumatic fracture (high or low energy) + Fatigue or stress fracture (repeated microtrauma without a single trauma – runners + military personnel + severe osteoporosis) + Pathological fracture (bone weakened by an underlying disease: osteoporosis + metastasis + myeloma + Paget's disease + bone cyst); Specific fractures in children: Greenstick fracture + Torus fracture + Salter-Harris epiphyseal separations (Salter-Harris classification I to V based on physeal plate involvement – classification influences growth prognosis) – any fracture in a child should raise suspicion of abuse if the mechanism is inconsistent with the injury.
- Clinical and radiological diagnosis: Clinical examination: sharp pain localized at the fracture site (cardinal sign) + visible deformity (angulation + shortening + rotation) + swelling + hematoma + bone crepitus on palpation (do not intentionally reproduce—painful + unnecessary + displaces the fragments) + functional impairment + systematic distal neurovascular assessment (distal pulse + sensation + motor function—always before and after any reduction maneuver); standard X-rays (two mandatory perpendicular views—anterior-posterior + lateral, plus 3/4 views depending on location): include the joint above and below on X-rays of long bones (risk of associated fracture or unrecognized dislocation) — non-displaced or greenstick fractures may be difficult to visualize — repeat on days 8–10 if there is strong clinical suspicion with a normal initial X-ray (edema and early bone resorption make the fracture line visible later); additional imaging depending on the context: MRI (gold standard for occult fractures + non-displaced femoral neck fractures + pathological bone lesions + stress fractures) — CT scan: indicated for complex fractures (pelvis + spine + tibial plateau + calcaneus + acetabulum + intra-articular fractures) + preoperative evaluation + occult fractures if MRI is unavailable + traumatic cervical fractures (NEXUS + Canadian C-Spine Rule) — bone scintigraphy: stress fractures + metastases + occult fractures if MRI is unavailable; clinical decision rules (to avoid unnecessary X-rays): Ottawa Ankle Rules: X-ray mandatory if malleolar pain + inability to bear weight × 4 steps or tenderness over the last 6 cm of the malleoli or the posterior edge of the base of the 5th metatarsal or the navicular bone — sensitivity 97–100 % for significant fracture + allows for the avoidance of 30–40 % ankle X-rays
- Neurovascular assessment and immediate complications not to be missed: Systematic assessment of distal neurovascular status before and after any procedure: radial pulse (humerus fracture + elbow) + femoral pulse + popliteal pulse + posterior tibial pulse + foot pulse (femur fracture + knee + tibia) + capillary refill time + sensation and motor function in at-risk nerve territories depending on the location; associated nerve injuries depending on location: proximal humerus fracture → axillary nerve (deltoid test + sensation in the shoulder stump) + diaphyseal humerus fracture → radial nerve (wrist extension test + finger extensors — drop hand) + supracondylar humerus fracture (children +++) → median nerve (distal interphalangeal flexion of the index finger = testing of the anterior interosseous nerve — OK sign) + radial nerve + humeral artery (vascular emergency) + fracture of the fibular neck → common peroneal nerve (testing of dorsiflexion + eversion of the foot — drop foot); compartment syndrome: surgical emergency — abnormally high pressure within a fascial compartment following post-traumatic edema or a hematoma → irreversible muscle and nerve ischemia if not treated within 6 hours — at-risk sites: leg (4 compartments) + forearm (3 compartments) + foot + thigh + arm — classic signs (5 P’s): Pain (disproportionate pain + worsened by passive stretching of the compartment muscles) + Paresthesias + Pallor + Pulselessness + Paralysis (late-onset) — treatment: emergency surgical fasciotomy — measurement of intracompartmental pressure: >30 mmHg or delta P (systolic blood pressure – compartmental pressure) <30 mmHg = indication for surgery; fat embolism: a rare complication of long bone fractures (femur +++) and pelvic fractures → fat marrow emboli in the circulation → triad: acute respiratory failure + neurological symptoms + petechiae (trunk + conjunctiva) → 24–72 hours after trauma + treatment: supportive care + early surgical stabilization of fracture sites (reduction of intraosseous bleeding)
Management of Major Fractures
| Type of fracture | Treatment and Techniques | Follow-up, consolidation, and complications |
|---|---|---|
| Orthopedic treatment — immobilization Plaster cast — splint — functional brace |
Orthopedic (non-surgical) treatment is indicated for fractures without displacement or with acceptable displacement after reduction, in locations where immobilization allows for proper healing without major functional risk; manual reduction (closed reduction) under local anesthesia, sedation, or general anesthesia: traction + counter-traction along the axis + specific corrective maneuver depending on the type of displacement → immediate post-reduction radiographic assessment + post-reduction neurovascular examination; plaster immobilization: circular cast: rigid immobilization + do not apply a circular cast within 24–48 hours after acute trauma (risk of compression due to edema → compartment syndrome) — emergency plaster splint (back-supported) followed by a circular cast at 48–72 hours once edema has stabilized; types of immobilization based on location: wrist fracture (Colles + Pouteau-Colles + Smith): splint followed by an antebrachial-palmar below-elbow cast × 4–6 weeks + position in slight palmar flexion and ulnar deviation (Colles) + radiographic follow-up at days 5–10 and day 21 to detect secondary displacement (common); metatarsal fractures (except Jones’ fifth metatarsal): rigid walking shoe (post-op shoe) + weight-bearing permitted + 4–6 weeks; clavicle fracture (without displacement or with moderate displacement): simple sling × 3–4 weeks + early pendulum rehabilitation; fracture of the upper humerus (non-displaced, two-part): simple splint + pendulum rehabilitation starting on days 7–14; fracture of the radial neck (radial head — Mason I–II): sling × 2–3 weeks + early mobilization + early pronosupination (to prevent stiffness); functional brace (Sarmiento): removable sleeve made of thermoplastic material — non-displaced or minimally displaced humeral diaphyseal fracture — allows for early mobilization of the shoulder and elbow → union rate 95–98% % + excellent functional outcomes | Monitoring of orthopedic treatment: routine follow-up X-rays: Days 5–10 (secondary displacement under the cast—common in unstable fractures) + Day 21 (early bone healing—visible callus) + Days 42–60 (complete bone healing)—criteria for urgent follow-up while in a cast: severe, unrelenting pain + tingling + numbness + blue or cold skin under the cast → urgent consultation → removal and assessment for compartment syndrome; Duration of immobilization depending on location and age: cancellous bone (vertebrae + foot bones + wrist): 4–6 weeks + long bones of the upper limbs (forearm + humerus): 6–8 weeks + long bones of the lower limbs (tibia + femur): 8–12 weeks + children: duration reduced by 30–50% (faster healing) + patients with osteoporosis: duration potentially increased + poor healing to be monitored; secondary displacement under cast: high risk within the first 10–14 days → routine radiographic follow-up at 8–10 days + if displacement is unacceptable → discuss surgery (percutaneous nailing + osteosynthesis) + criteria for acceptable residual displacement vary by location: wrist (Colles): dorsal angulation <10° + radial shortening <5 mm + radial deviation <5°; tibia: angulation <5° in all planes + shortening <12 mm + rotation <10°; delayed union and pseudarthrosis: delayed union = absence of radiographic signs of union beyond the usual timeframe (× 1.5) + pseudarthrosis = absence of union at 9–12 months despite proper treatment → risk factors: smoking (delays union by 4–6 weeks) + malnutrition + osteoporosis + infection + insufficient blood supply + residual displacement + instability of the fracture site → treatment: osteosynthesis + bone grafting + electrical or ultrasound stimulation (LIPUS — low-intensity pulsed ultrasound) |
| Surgical treatment — osteosynthesis Nailing — plate screw — percutaneous screws |
Surgical treatment is indicated for unstable displaced fractures that cannot be managed with conservative orthopedic treatment, intra-articular fractures requiring anatomical reduction, open fractures, and fractures of the lower extremities in active adults (allowing for early weight-bearing); intramedullary nailing (intramedullary nail — IMN): the gold standard technique for diaphyseal fractures of long bones (femur, tibia, and humerus)—insertion of a metal nail into the bone’s medullary canal + proximal and distal locking with transverse screws → rotational and axial stability → early weight-bearing → union under physiological stress—diaphyseal femoral fracture: CCM in deferred emergency cases (6–24 hours to optimize hemodynamics) — locked CCM → partial weight-bearing on Day 1 + full weight-bearing on Days 30–45 — union rate 95–98% at 12 months; screw-fixed plate osteosynthesis: indications: metaphyseal + epiphyseal + intra-articular fractures + displaced clavicle fractures + complex proximal humerus fractures + displaced distal radius fractures + bimalleolar ankle fractures + locking compression plates (LCP): dual compression mechanism + angular locking → superior stability in osteoporotic bone; Percutaneous screws (closed-system osteosynthesis): cross-shaped calcaneal fractures + fractures of the base of the 5th metatarsal + medial malleolar fractures + scaphoid fractures + cannulated screws for the upper femur (non-displaced femoral neck fractures in young patients); external fixator: indicated as an emergency measure for Gustilo grade II–III open fractures (temporary stabilization of the fracture site prior to definitive osteosynthesis) + unstable pelvic fractures + complex lower extremity fractures with soft tissue injuries + multiple trauma (damage control orthopedics) | Fractures requiring urgent or delayed emergency surgery: open fracture: surgical irrigation + debridement + stabilization of the fracture site within 6–8 hours (optimal timeframe) → prophylactic IV antibiotics (cefazolin + gentamicin if Grade III) → delayed skin closure at 48–72 hours unless clean Grade I → risk of bone infection (osteitis) directly related to the delay in treatment and the Gustilo grade; displaced femoral neck fracture in the elderly (Garden III–IV): hip replacement (hemiarthroplasty or total hip replacement depending on biological age + activity level + life expectancy) within 24–48 hours → reduced 1-year mortality if surgery is performed within 48 hours (1-year mortality: 25–30% in adults >80 years old even after optimal surgery) → systematic postoperative anticoagulation (LMWH + transition to DOACs — duration 35 days after hip replacement) + physical therapy on postoperative day 1; displaced supracondylar humeral fracture in children (Gartland type III): emergency percutaneous pinning (2 divergent Kirschner wires) + cast with elbow flexed at 90° × 3 weeks — feared complication: forearm ischemia (humeral artery) + median nerve (anterior interosseous) → emergency pin removal + vascular exploration if pallor + loss of radial pulse; acetabular fracture + unstable pelvic fracture (Tile C): elective surgery within 5–7 days (after hemodynamic stabilization and patient stabilization) + emergency external fixator if hemodynamic instability due to rupture of the presacral veins; total arthroplasty (prosthesis): femoral neck fracture in the elderly adult + irreducible comminuted fracture of the humeral head + pathological fracture involving a loosened prosthesis |
| Osteoporotic fractures Wrist — vertebra — hip — shoulder |
Osteoporotic fractures—also known as fragility fractures—occur as a result of low-energy trauma (a fall from standing height) to a bone whose mineral density and microarchitectural quality have been compromised by osteoporosis; epidemiology in Quebec: 1 in 3 women and 1 in 5 men over the age of 50 will suffer an osteoporotic fracture during their lifetime—hip fractures result in a mortality rate of 20–25% of cases within 1 year + permanent loss of independence in 30–40% of cases among the elderly — a major economic burden for the Quebec healthcare system; most common osteoporotic fractures: distal wrist fracture (Colles — the most common before age 65 — fall onto an outstretched palm) + vertebral compression fracture (the most common fracture after age 65 — often asymptomatic + discovered incidentally on a chest X-ray or bone densitometry) + femoral neck fracture and trochanteric fracture (the most serious—80,000 hip fractures/year in Canada) + proximal humerus fracture (3rd most common); post-fracture evaluation: bone densitometry (DEXA): mandatory after any fragility fracture — T-score (comparison to a young adult of the same sex): osteoporosis <−2.5 + osteopenia −2.5 to −1.0 + normal >−1.0; Laboratory workup: serum calcium + serum phosphorus + 25-OH-vitamin D + PTH + complete blood count (CBC) + TSH + protein electrophoresis (myeloma) + creatinine + alkaline phosphatase + CTX (C-telopeptide — marker of bone resorption) + testosterone (men) + liver function tests; FRAX (Fracture Risk Assessment Tool — WHO): calculation of the 10-year absolute risk of major fracture and 10-year risk of hip fracture — includes: age + sex + BMI + personal and family history of fracture + smoking + alcohol + corticosteroid therapy + rheumatoid arthritis + secondary causes of osteoporosis + femoral T-score — pharmacological treatment threshold recommended by Osteoporosis Canada: 10-year risk of major fracture >20 % or 10-year risk of hip fracture >3 % | Treatment of osteoporosis following a fragility fracture — FLS (Fracture Liaison Service) program: calcium + vitamin D supplementation: calcium 1,200 mg/day (diet + supplement if intake is insufficient) + vitamin D 800–2,000 IU/day (target 25-OH-D >75 nmol/L) — bisphosphonates (first-line anti-osteoporotic treatment): alendronate (Fosamax) 70 mg/week PO — risedronate (Actonel) 35 mg/week or 150 mg/month PO — zoledronate (Aclasta — Reclast) 5 mg IV annually (first-line option if gastrointestinal intolerance or oral non-compliance) — duration of treatment: 3–5 years + benefit/risk reassessment (discontinuation of bisphosphonate therapy if moderate risk after 5 years + continuation if high risk) + rare adverse effects: osteonecrosis of the jaw (very low risk <0.001 per 10,000 patients — to be distinguished from higher doses used in oncology) + atypical femoral fracture (subtrochanteric diaphyseal — warning sign: bilateral thigh pain + thickened lateral cortex on X-ray); denosumab (Prolia): anti-RANKL monoclonal antibody — 60 mg SC every 6 months — second-line treatment or if bisphosphonates are contraindicated (renal failure — eGFR <30) + do not stop abruptly (rebound cascade of vertebral fractures if stopped without bisphosphonate bridging therapy); risedronate or zoledronate IV in cases of hip fracture: start within 2–12 weeks post-surgery (after healing); teriparatide (Forteo): recombinant PTH — 20 µg SC/day × 24 months — bone anabolic agent — reserved for severe osteoporosis with multiple vertebral fractures or inadequate response to anti-osteoclastics — reimbursed by RAMQ under exceptional criteria; FLS program in Quebec: fracture liaison service (FLS) — nurse coordinators at the university hospital + automatic communication between the emergency department and the attending physician following a fragility fracture → initiation of anti-osteoporotic treatment within 3 months post-fracture (post-fracture treatment rate in Canada without FLS: 20% % → with FLS: 70–80% %) |
| Stress fractures and pathological fractures Overwork — neoplasm — loading prohibited |
Stress (fatigue) fractures: occur without a single traumatic event—result from repeated microtrauma exceeding the bone’s remodeling capacity—two mechanisms: overuse of normal bone (fatigue fracture—athletes, military personnel, dancers) and normal stress on weakened bone (insufficiency fracture—osteoporosis, corticosteroid therapy); common sites of stress fractures: metatarsals (2nd and 3rd — excessive walking + beginning of training) + calcaneus (military recruits) + tibia (runners — progressive medial tibial pain) + fibula + femoral neck (do not miss — risk of progression to a displaced complete fracture if not unloaded) + sacral vertebrae (osteoporotic insufficiency — gluteal pain) + navicular bone (sports); diagnosis: initial X-ray often normal in the first 2–3 weeks (sensitivity 50–70% in the early stage) → MRI (gold standard — sensitivity and specificity >90% from day 3–day 7) + bone scan (sensitive but not very specific) + CT scan (visualizes the line if MRI is unavailable); treatment of stress fractures: low risk (metatarsals + fibula + tibia, low-energy): partial weight-bearing + rigid shoe + cessation of sports activity for 4–6 weeks + gradual return to activity; high risk (femoral neck + navicular bone + base of the 5th metatarsal + sesamoid bones + anterior tibial isthmus): no weight-bearing + urgent MRI + orthopedic consultation → surgery if complete fracture or high risk of displacement (percutaneous screws in the femoral neck for fatigue fractures of the neck); factors contributing to stress fractures: the female athlete triad: energy deficit + amenorrhea + osteoporosis — RED-S (relative energy deficiency in sport): screening and nutritional + hormonal + psychological management; Pathological fractures: definition: a fracture occurring in a pathologically weakened bone (neoplasm + multiple myeloma + Paget’s disease + bone cyst + fibrous dysplasia + severe osteomalacia) following minimal or no trauma; suggestive signs: fracture from disproportionate trauma + osteolytic lesion visible on X-ray + pre-existing chronic bone pain + known neoplastic history or risk factors (smoking + breast/prostate/lung/kidney/thyroid cancer — the 5 cancers most likely to metastasize to bone); workup: CT scan + MRI of the bone segment + whole-body bone scan (to detect multiple lesions) + FDG-PET + laboratory workup (complete blood count + serum protein electrophoresis + PSA + CA15-3 + other markers as clinically indicated) + biopsy of the lesion if histology is unknown | Management of pathological fractures: prophylactic osteosynthesis: indicated before a complete fracture occurs if the lesion presents a high risk of imminent fracture — Mirels criteria (score of 0 to 12, including location, nature, and size of the lesion, plus pain): score ≥9 → prophylactic surgery; established pathological fracture: surgical stabilization (intramedullary nailing + endoprosthesis) to allow mobility + improve quality of life + facilitate locoregional radiation therapy (radiation therapy on an unstable bone metastasis cannot precede surgery—risk of intraoperative fracture); palliative radiotherapy: after surgical stabilization → control of bone pain (efficacy 70–80% %) + reduction in the risk of local progression; systemic treatments: IV bisphosphonates (zoledronic acid 4 mg IV every 3–4 weeks) + denosumab (Xgeva — 120 mg SC every 4 weeks) → reduction in skeletal events (fractures, spinal cord compression, and need for bone surgery) in bone metastases from solid carcinomas and multiple myeloma + monitoring: serum calcium + creatinine before each dose of zoledronic acid (risk of nephrotoxicity) + dental evaluation before initiation (osteonecrosis of the jaw is more common at oncological doses than at anti-osteoporotic doses); pathological vertebral fracture with imminent or established spinal cord compression: neurosurgical emergency → decompression + stabilization + corticosteroids (dexamethasone 10 mg IV bolus + 4 mg × 4/day) + stereotactic (SBRT) or conventional radiation therapy according to the oncology protocol |
| Consolidation, rehabilitation, and late complications Physical therapy — osteitis — malunion |
Functional rehabilitation is an integral part of fracture treatment—it should ideally begin within the first few days of care to prevent complications from immobilization and optimize functional outcomes; Principles of post-fracture rehabilitation: early mobilization of non-immobilized joints (prevention of joint stiffness + stimulation of circulation) + isometric muscle contractions while in a cast (prevention of muscle atrophy) + progressive weight-bearing under the supervision of a physical therapist based on the type of fracture and the treatment performed + objectives: restoration of full joint range of motion + muscle strength + proprioception + functional endurance; timing of weight-bearing based on treatment: diaphyseal femur fracture under CCM: walking with partial weight-bearing on Days 1–3 + full weight-bearing on Days 30–60 + tibial fracture under CCM: partial weight-bearing on Days 7–14 + full weight-bearing on Days 30–45 + hip fracture under total prosthesis: full weight-bearing on postoperative Day 1 (RAAC protocol — enhanced recovery after surgery) + wrist fracture in a cast: mobilization of the fingers starting on Day 1 + of the adjacent joints upon cast removal (Days 42–60); late complications of bone healing: malunion: union in an anatomically incorrect position (angulation + shortening + rotation) → consequences: leg length discrepancy (shortening >2 cm → gait disturbance) + early osteoarthritis if intra-articular malunion + functional impairment → treatment: corrective osteotomy (recuts the bone to realign it) if significant functional impairment; pseudarthrosis (nonunion): lack of union at 9–12 months — Weber-Cech classification: hypertrophic (preserved vascularization — mechanical instability → rigid osteosynthesis) + atrophic (insufficient vascularization → osteosynthesis + bone graft + growth factors) + ultrasound stimulation (LIPUS) or electrostimulation; osteitis (post-fracture bone infection): primary risk associated with open fractures + bone surgeries → Staphylococcus aureus predominant + MRSA in nosocomial settings → prolonged antibiotic therapy (6–12 weeks) guided by culture + surgical debridement + removal of osteosynthesis hardware if possible (after union) + reconstruction (bone graft + bone transport — Ilizarov method — if significant bone loss) | Complex Regional Pain Syndrome (CRPS — formerly reflex sympathetic dystrophy): a feared complication of fractures (wrist+++): disproportionate pain + allodynia + edema + trophic disorders (smooth shiny skin or hyperpigmented skin + abnormal sweating) + local osteoporosis on scintigraphy (CRPS type I — without identifiable nerve lesion) — risk factors: prolonged immobilization + anxiety + smoking + wrist fracture in menopausal women — treatment: physical therapy in balneotherapy + gentle desensitizing mobilization + medications: gabapentin + NSAIDs + calcitonin (nasal spray 200 IU/day × 4 weeks — limited data) + IV bisphosphonates (pamidronate 30 mg × 3 infusions — some positive studies) + sympathectomy or stellate ganglion blocks if refractory CRPS; prevention of post-fracture thromboembolic complications: deep vein thrombosis + pulmonary embolism → high risk for lower limb and pelvic fractures → prophylactic LMWH (enoxaparin 40 mg SC/day) upon admission + until full weight-bearing + duration: 10–14 days for surgically treated fractures + 35 days for hip or knee replacement; elastic compression stockings + early mobilization + ankle exercises + hydration; nutrition and bone healing: protein 1.2–1.5 g/kg/day (essential for collagen matrix formation) + calcium 1,200 mg/day + vitamin D 800–2,000 IU/day + zinc + vitamin C (co-factor for collagen synthesis) + smoking cessation (significantly improves healing); Quebec resources: orthopedic emergencies at university hospitals + private orthopedic clinics + certified physical therapists in orthopedic rehabilitation + ERAS programs at university hospitals for arthroplasties |
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Fatigue fracture of the femoral neck — overlooked emergency: A stress fracture of the femoral neck is a serious injury that is often overlooked because the initial X-ray is normal in more than 50% of cases. It primarily affects long-distance runners, military personnel, and women with the "athlete's triad." Weight-bearing must be immediately prohibited upon clinical suspicion (groin pain ± pain with hip internal rotation), and an MRI must be performed urgently. Failure to provide prompt treatment can lead to a displaced comminuted fracture requiring a hip replacement, with all the associated long-term functional consequences.
Situations requiring urgent care
Open fracture (bone visible or communicating wound) → orthopedic emergencies → irrigation + surgical debridement + IV antibiotics within 6–8 hours.
Fracture + absent distal pulse or disproportionate pain + paresthesias + tense compartment → vascular lesion or compartment syndrome → immediate surgery (fasciotomy or vascular repair).
Spinal fracture with neurological deficit (limb weakness + sphincter dysfunction) → Spinal cord compression → Neurosurgical emergency → Spine MRI + IV dexamethasone + surgery or radiotherapy depending on etiology.
Thigh or hip pain in a runner + normal X-ray → Stress fracture of the femoral neck to rule out → MRI urgently + immediate weight bearing.
Consult at Clinique Omicron
Clinique Omicron physicians assess bone trauma, refer to orthopedic emergencies if necessary, and provide follow-up care for fractures undergoing orthopedic treatment (radiological check-ups, cast monitoring, prescription of physical therapy). The investigation and treatment of osteoporosis following a fragility fracture—including bone densitometry, FRAX score calculation, and prescription of anti-osteoporotic agents—are an integral part of the care provided at several service points in Quebec and via telemedicine. To book an appointment, visit cliniqueomicron.ca.
The content of this page is for informational purposes only and does not replace the evaluation of a doctor or orthopedic surgeon. Any suspected fracture requires medical consultation and an X-ray.
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