A fracture is a complete or incomplete break in a bone.


  • Trauma e.g. road traffic accident, assault, falls, sports
  • Bone weakening by disease, e.g., cancer, TB, osteomyelitis, osteoporosis

Clinical features

  • Pain, tenderness, swelling, deformity
  • Inability to use/move the affected part
  • May be open (with a wound) or closed

Differential diagnosis

  • Sprain, dislocations
  • Infection (bone, joints and muscles)
  • Bone cancer


  • X-ray: 2 views (AP and lateral) including the joints above and below


Suspected fractures should be referred to orthopaedics after initial care.

If polytrauma

  • Assess and manage airways
  • Assess and treat shock

Closed fractures

  • Assess nerve and blood supply distal to the injury:
    if no sensation/pulse, refer as an emergency
  • Immobilise the affected part with a splint
  • Apply ice or cold compresses
  • Elevate any involved limb
  • Give an analgesic e.g. paracetamol 1 g every 6-8
    hours to relieve pain

    Child: 10 mg/kg every 6-8 hours

  • For severe pain, use opioids stat
    • Morphine 5-10 mg IV or Pethidine 50-100 mg IM
  • Refer to hospital for further management

Open fractures

  • Stop any bleeding by applying pressure
  • Clean open wound and cover with sterile dressing
  • Give Tetanus Toxoid if not fully vaccinated
  • Start antibiotic
    • Amoxicillin 500 mg every 8 hours

      Child: 25 mg/kg every 8 hours (or 40 mg/kg every
      12 hours)

If severe soft tissue damage

  • Add gentamicin 2.5 mg/kg every 8 hours
  • Refer URGENTLY to hospital for further


  • Treat sprains, strains and dislocations as above


  • Do not give pethidine and morphine for rib fractures and
    head injuries as they cause respiratory depression