Without an x-ray to help, it's nearly impossible to tell when or if you have a fracture. There are layers of skin, muscle and fat between your eyes and the possibly broken bone. Some folks believe you can tell if a bone is broken by whether or not you can use it, such as a young athlete who thinks his leg isn't broken because he can walk on it. Many times, the only thing keeping you from walking on a broken leg or using a broken arm is the pain.
You can safely assume that any fracture is going to hurt. Beyond the obvious symptom of pain, you should probably go to the doctor if you have one or more of the following:
The discoloration of an injury shows that blood has escaped from the capillaries in the area, which means the tissue has been damaged underneath. Bruising can happen with almost any kind of tissue damage, including blood leaking from a broken bone.
Injuries cause fluids and sometimes blood to leak into soft tissues like muscle, fat and skin. All that extra fluid causes the soft tissues to swell (think how a dry sponge swells up when you add water) and become taut or hard.
Out of all four of these signs, deformity is probably the most likely indicator of a fracture. When the arm or leg bends in places it's not supposed to bend, it's a good bet there's a bone out of place. Likewise, if the bone is sticking out through the skin, I'd put money on the fact that it's broken -- or maybe even dislocated (see below).
You know that crunchy feeling you get under your feet when you're walking on gravel? That's crepitus. You're not supposed to feel that in the body. When you do, it's usually because broken bits of bone are rubbing together.
Fractures aren't the only type of serious orthopedic injury. Dislocations -- when a joint like a knee or shoulder gets seriously out of alignment -- can be worse than fractures. In most cases, a broken bone stays pretty well where it's supposed to. Dislocations by definition are deformed and cause stretching, sometimes even tearing, of ligaments and tendons. Dislocations not only are deformed, they can limit movement or make a joint entirely immobile.
You might not go to the emergency department for simple pain or swelling, but since dislocations are so complicated it's worth that trip to the ER. If you can't get yourself there, dislocations are worthy of a call to 911.
Doctor's Office or ER?
It's not necessary to call an ambulance for a fracture. Besides not calling 911, you might not even go to the emergency department for simple pain, bruising or swelling.
Going to your private doc is fine for most broken bones, but any doctor -- including your private physician -- will certainly want to see an x-ray. If you choose to go to your private doctor instead of the ER, expect to go to an imaging center for an x-ray if your doctor can't do one in the office.
Whether you go to the ER or to your private doctor, you'll most likely have to get a temporary splint and then see the orthopedic specialist in a day or two. The orthopedic doctor will take care of the permanent cast. She'll also decide if you need surgery to repair the fracture.
The doctor will give you specific instructions for treatment, but a good rule of thumb is to treat any potential fracture or sprain with RICE:
- Rest the injured arm or leg
- Ice the injury to cool it down
- Compress it by wrapping it with a compression (Ace) bandage
- Elevate the injured arm or leg above the level of the heart