Clinical Findings

• Sudden pain in leg/hip/back/shoulder/arm while moving in bed, transferring to wheelchair or stretcher, or ambulating. Audible crack may be heard.
• Abnormal or limited motion of extremity.
• Back pain (with spinal compression fracture).
• Unexplained ecchymosis, edema over bone or joint.
• Obvious deformity of extremity.

Possible Causes: Osteoporosis, osteomalacia, primary bone tumors, metastatic bone lesions, Paget’s disease.

Collaborative Management

• Immobilize extremity in its position. Do not attempt to realign bone.
• Assess VS and LOC.
• Assess extremity for swelling or hematoma.
• Assess sensation and mobility of fingers or toes distal to injury if extremity fracture is suspected.
• Assess mobility and sensation of arms and legs if spinal fracture suspected.
• Assess history of falls or fractures.
• Determine extent of injury and provide pain relief.
• Assist with diagnostic procedures (x-ray or bone scan).
• Prepare Pt for surgery, if applicable.
• Assist with casting or immobilization with splint or traction.
• Monitor foot or hand of affected extremity for peripheral neurovascular dysfunction.
• Initiate rehabilitation consultation.
• Initiate care to prevent complications of restricted mobility, such as foot and ankle exercises to decrease risk of DVT, early mobilization, and cough and deep-breathing exercises.
• Initiate pressure ulcer prevention strategies.
• Protect Pt from additional injury.
• Obtain assistive devices for ambulation or self-care activities.