Children’s bones usually heal rapidly and without deformity. Bones of adults in poor health and with impaired circulation may never heal properly. Severe open fractures, especially of the femoral shaft, may cause substantial blood loss and life-threatening hypovolemic shock.
Causes
Most arm and leg fractures result from major trauma—for example, a fall on an outstretched arm, a skiing accident, or child abuse (shown by multiple or repeated episodes of fractures). However, in a person with a pathologic bone-weakening condition, such as osteoporosis, bone tumors, or metabolic disease, a mere cough or sneeze can also produce a fracture. Prolonged standing, walking, or running can cause stress fractures of the foot and ankle—usually in nurses, postal workers, soldiers, and joggers.
Signs and symptoms
Arm and leg fractures may produce any or all of the five Ps: pain and point tenderness, pallor, pulse loss, paresthesia, and paralysis. (The last three are distal to the fracture site.) Other signs include deformity, swelling, discoloration, crepitus, and loss of limb function. Numbness and tingling, mottled cyanosis, cool skin at the end of the extremity, and loss of pulses distal to the injury may indicate arterial compromise or nerve damage. Open fractures also produce an obvious skin wound.
