Without an X-ray, it's nearly impossible to tell when—or if—the patient has a fracture. There are layers of skin, muscle, and fat between the rescuer's eyes and the possible broken bone.
Some folks believe they can tell if a bone is broken by whether or not the patient can use it, such as a young athlete who thinks his leg isn't broken because he can walk on it. That's a myth. Many times, the only thing keeping a patient from walking on a broken leg or using a broken arm is the pain.
Sometimes, a really bad complete fracture will not be able to carry weight or otherwise function properly. Most of the time, however, fractures can indeed support weight. The patient can probably even walk on a broken leg—it just hurts like the dickens.
You can safely assume that any fracture is going to hurt, so pain is not on this list. If the patient has a mechanism of injury and it hurts pretty bad, she should go to the doctor if she also has one or more of these signs.
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.1 The bigger the area of bruising, the more likely the damage is deep—possibly bone deep.
Broken bones often swell. Swelling can be a sign that it's broken.2
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 we add water) and become taut or hard. Swelling can happen from medical conditions without trauma as well. However, if it only happens after an injury, it's probably related.
Out of all four of these signs, deformity is arguably the best indicator of a fracture.3 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, we can put money on the fact that it's broken—or maybe even dislocated.
You know that crunchy feeling you get under your feet when you're walking on gravel? When a rescuer feels that crunchiness under the skin, it's called crepitus.4 You're not supposed to feel that in the body. If it's there, it's usually because broken bits of bone are rubbing together.
Should You Go to the Emergency Room?
It's not necessary to call an ambulance for a fracture. Besides not calling 911, a patient might not even go to the emergency department for simple pain, bruising or swelling.
Going to a private doctor is fine for most broken bones, but any doctor—including a primary care physician—will certainly want to see an X-ray. If the patient chooses to go to a private doctor instead of the ER, he should expect to go to an imaging center for an x-ray if the doctor can't do one in the office.
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 be. Dislocations, by definition, are deformed and cause stretching—and sometimes even tearing—of ligaments and tendons.5 Dislocations not only are deformed, they can limit movement or make a joint entirely immobile.
The patient 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 the patient can't get there on her own, dislocations are worthy of a call to 911.
METH Method, not RICE
The doctor will give specific instructions for treatment, but a good rule of thumb is to treat any potential fracture with the METH method, rather than the well-known RICE method:
Movement of the injured extremity: Flex and extend what you can, although you might have to immobilize part or all of your extremity to allow it to heal.
Elevate the injured arm or leg above the level of the heart
Traction might be useful. This is something your doctor will have to show you how to do if she thinks it will help.
Heat. Apply warm, moist heat to the area several times per day. Don't make it too hot or leave it on longer than half an hour.
Avoid anti-inflammatory medications if it might be a fracture. Anything that stops the inflammatory process is essentially stopping healing. The immune response (the body healing itself) is the reason we get inflammation.6 Don't stop it; encourage it.
A Word From Verywell
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.
Given proper healing time, rest, and following your doctor's instructions, you should be on your way to a healed bone if it is broken.