What are the key clinical signs and symptoms to assess when evaluating a suspected fracture in a primary care setting?

When evaluating a suspected fracture in a primary care setting, key clinical signs and symptoms to assess include:

• History of injury: Mechanism of injury, including the force and direction of trauma, and timing of the injury.
• Pain: Localised pain at the suspected fracture site, often severe and exacerbated by movement.
• Swelling and deformity: Visible swelling, bruising, or abnormal angulation or shortening of the limb.
• Loss of function: Inability or reluctance to use or bear weight on the affected limb or joint.
• Neurovascular status: Assess for numbness, tingling, motor weakness, and check distal pulses to exclude nerve or vascular injury.
• Skin integrity: Look for open wounds or signs of an open fracture.
• Range of motion: Limited or painful movement of the affected area.
• Signs of complications: Such as compartment syndrome (increasing pain, pallor, pulselessness), or signs of non-accidental injury in children.

Documenting neurovascular status carefully, including sensory and motor function and pulse assessment, is essential and should be repeated and timed.

These assessments help determine the need for urgent referral or imaging and guide initial management in primary care ¹,².