Pitfalls in simple fracture care.

Many errors in diagnosing simple fractures are made because of inadequate roentgenography and inexperience in interpretation. Two views are almost always needed, and in some cases more. An x-ray film of the opposite uninjured extremity may be helpful for comparison. In many instances, stress views can differentiate bone injury and ligament injury. The first physical examination after injury must be thorough, with a search for peripheral nerve injury and vascular injury. A cast should not be used if certain conditions are present, eg, severe dermatitis, circulatory problems, venous insufficiency, paraplegia. When applying a cast, care must be taken to position the body structure correctly, include only the joints necessary, avoid too tight application, and choose the proper cast length. Prolonged immobilization can result in joint stiffness or even disability. The patient should be warned about danger signals, such as pain, numbness, and cyanosis, and should be monitored regularly for complications.