Extremity injury / suspected fracture
A streamlined, differential-led presentation for rapid clinical review.
Twenty-second review
- Extremity trauma can injure bone, joint, muscle, tendon, nerve, and vessels; swelling and displacement may progressively compromise tissue perfusion.
- Absent distal pulse, expanding swelling, open fracture, threatened skin, severe pain out of proportion, or major hemorrhage requires urgent action.
- Keep referred pain or pathologic fracture in the differential; overlapping or concurrent illness remains possible.
- For extremity injury / suspected fracture, trends and combinations of findings are more informative than one isolated vital sign.
Compare the clinical patterns
The repeated material is grouped inside each possibility. Open only the condition you need.
Neurovascular compromiseTime-sensitive high-risk possibility
HPI
Clarify mechanism; open or closed; deformity.
Signs & symptoms
Absent pulse, paresthesia, weakness, tense swelling, or escalating pain.
Focused exam
Expose only as needed, inspect and palpate systematically, and document distal circulation, sensation, and movement; Reassess pain, swelling, perfusion, and neurologic status after movement or intervention.
Brief pathophysiology
Neurovascular compromise may cause extremity injury / suspected fracture through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
Isolated musculoskeletal injury often leaves central vital signs near baseline. Persistent abnormality should prompt reassessment for hemorrhage, thoracic injury, infection, or a medical cause.
Heart rate (bpm)
May rise with painTachycardia can reflect pain or distress; trend after treatment.
Blood pressure (mmHg)
May rise with painHypotension is not expected in an isolated minor injury.
Respiratory rate (breaths/min)
May rise with painPersistent tachypnea suggests more than a minor isolated injury.
Oxygen saturation (SpO₂)
Usually preservedDesaturation suggests thoracic injury or concurrent disease.
Front-load in the triage report
- Neurovascular compromise: Absent pulse, paresthesia, weakness, tense swelling, or escalating pain.
- Mechanism.
- Open or closed?
Compartment syndromeTime-sensitive high-risk possibility
HPI
Clarify open or closed; deformity; location.
Signs & symptoms
Absent pulse, paresthesia, weakness, tense swelling, or escalating pain.
Focused exam
Reassess pain, swelling, perfusion, and neurologic status after movement or intervention; Inspect alignment and skin, palpate gently, assess joint above and below, and document distal circulation, sensation, and movement before and after intervention.
Brief pathophysiology
Compartment syndrome may cause extremity injury / suspected fracture through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
Isolated musculoskeletal injury often leaves central vital signs near baseline. Persistent abnormality should prompt reassessment for hemorrhage, thoracic injury, infection, or a medical cause.
Heart rate (bpm)
May rise with painTachycardia can reflect pain or distress; trend after treatment.
Blood pressure (mmHg)
May rise with painHypotension is not expected in an isolated minor injury.
Respiratory rate (breaths/min)
May rise with painPersistent tachypnea suggests more than a minor isolated injury.
Oxygen saturation (SpO₂)
Usually preservedDesaturation suggests thoracic injury or concurrent disease.
Front-load in the triage report
- Compartment syndrome: Absent pulse, paresthesia, weakness, tense swelling, or escalating pain.
- Open or closed?
- Deformity?
Closed fractureCommon presentation pattern
HPI
Clarify mechanism; open or closed; deformity.
Signs & symptoms
Focal pain, swelling, deformity, and loss of function are common patterns.
Focused exam
Expose only as needed, inspect and palpate systematically, and document distal circulation, sensation, and movement; Reassess pain, swelling, perfusion, and neurologic status after movement or intervention.
Brief pathophysiology
Closed fracture may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.
What the trend may show
Isolated musculoskeletal injury often leaves central vital signs near baseline. Persistent abnormality should prompt reassessment for hemorrhage, thoracic injury, infection, or a medical cause.
Heart rate (bpm)
May rise with painTachycardia can reflect pain or distress; trend after treatment.
Blood pressure (mmHg)
May rise with painHypotension is not expected in an isolated minor injury.
Respiratory rate (breaths/min)
May rise with painPersistent tachypnea suggests more than a minor isolated injury.
Oxygen saturation (SpO₂)
Usually preservedDesaturation suggests thoracic injury or concurrent disease.
Front-load in the triage report
- Focal pain, swelling, deformity, and loss of function are common patterns.
- Mechanism.
- Open or closed?
Soft-tissue injuryCommon presentation pattern
HPI
Clarify open or closed; deformity; location.
Signs & symptoms
Focal pain, swelling, deformity, and loss of function are common patterns.
Focused exam
Reassess pain, swelling, perfusion, and neurologic status after movement or intervention; Inspect alignment and skin, palpate gently, assess joint above and below, and document distal circulation, sensation, and movement before and after intervention.
Brief pathophysiology
Soft-tissue injury may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.
What the trend may show
Isolated musculoskeletal injury often leaves central vital signs near baseline. Persistent abnormality should prompt reassessment for hemorrhage, thoracic injury, infection, or a medical cause.
Heart rate (bpm)
May rise with painTachycardia can reflect pain or distress; trend after treatment.
Blood pressure (mmHg)
May rise with painHypotension is not expected in an isolated minor injury.
Respiratory rate (breaths/min)
May rise with painPersistent tachypnea suggests more than a minor isolated injury.
Oxygen saturation (SpO₂)
Usually preservedDesaturation suggests thoracic injury or concurrent disease.
Front-load in the triage report
- Focal pain, swelling, deformity, and loss of function are common patterns.
- Open or closed?
- Deformity?
Referred painImportant alternative presentation
HPI
Clarify mechanism; open or closed; deformity.
Signs & symptoms
Symptoms may originate proximally or from weakened bone.
Focused exam
Expose only as needed, inspect and palpate systematically, and document distal circulation, sensation, and movement; Reassess pain, swelling, perfusion, and neurologic status after movement or intervention.
Brief pathophysiology
Referred pain can resemble extremity injury / suspected fracture through overlapping symptoms or referred physiology despite a different primary mechanism.
What the trend may show
Isolated musculoskeletal injury often leaves central vital signs near baseline. Persistent abnormality should prompt reassessment for hemorrhage, thoracic injury, infection, or a medical cause.
Heart rate (bpm)
May rise with painTachycardia can reflect pain or distress; trend after treatment.
Blood pressure (mmHg)
May rise with painHypotension is not expected in an isolated minor injury.
Respiratory rate (breaths/min)
May rise with painPersistent tachypnea suggests more than a minor isolated injury.
Oxygen saturation (SpO₂)
Usually preservedDesaturation suggests thoracic injury or concurrent disease.
Front-load in the triage report
- Symptoms may originate proximally or from weakened bone.
- Mechanism.
- Open or closed?
Pathologic fractureImportant alternative presentation
HPI
Clarify open or closed; deformity; location.
Signs & symptoms
Symptoms may originate proximally or from weakened bone.
Focused exam
Reassess pain, swelling, perfusion, and neurologic status after movement or intervention; Inspect alignment and skin, palpate gently, assess joint above and below, and document distal circulation, sensation, and movement before and after intervention.
Brief pathophysiology
Pathologic fracture can resemble extremity injury / suspected fracture through overlapping symptoms or referred physiology despite a different primary mechanism.
What the trend may show
Isolated musculoskeletal injury often leaves central vital signs near baseline. Persistent abnormality should prompt reassessment for hemorrhage, thoracic injury, infection, or a medical cause.
Heart rate (bpm)
May rise with painTachycardia can reflect pain or distress; trend after treatment.
Blood pressure (mmHg)
May rise with painHypotension is not expected in an isolated minor injury.
Respiratory rate (breaths/min)
May rise with painPersistent tachypnea suggests more than a minor isolated injury.
Oxygen saturation (SpO₂)
Usually preservedDesaturation suggests thoracic injury or concurrent disease.
Front-load in the triage report
- Symptoms may originate proximally or from weakened bone.
- Open or closed?
- Deformity?
Findings that should escalate concern
- Absent distal pulse, expanding swelling, open fracture, threatened skin, severe pain out of proportion, or major hemorrhage requires urgent action.
- Neurovascular compromise or compartment syndrome: Absent pulse, paresthesia, weakness, tense swelling, or escalating pain.
Continue the clinical pathway
Clinical and academic sources
Curated clinical guidance and peer-reviewed evidence supporting this presentation. Current BCEHS guidance, medical direction, and local policy remain authoritative for practice.
BCEHS Handbook — specific CPGs
Supporting clinical and academic evidence
- CEDIS Presenting Complaint List updateCanadian Association of Emergency Physicians
Presenting-complaint terminology and categorization context. It does not establish a prehospital “top 100” ranking.
- Major trauma: assessment and initial managementNational Institute for Health and Care Excellence
Evidence-based initial assessment, hemorrhage control, imaging, and trauma-system guidance.
- Guidelines for the acute care of severe limb traumaAnaesthesia Critical Care & Pain Medicine · 2021
Neurovascular assessment, hemorrhage control, limb-threatening injury, analgesia, and transport priorities.