When to Go to the Emergency Room for a Possible Broken Bone

Call 911 for a bone visible through the skin, a suspected head, neck, back, hip or pelvis injury, a limb that is pale or numb, or bleeding you cannot control. Do not move somebody with a suspected neck or back injury. Splint it as you found it — never straighten it.

Here is the problem with this question, stated honestly: the symptoms of a break and the symptoms of a bad sprain are nearly the same.

The American College of Emergency Physicians lists the signs of a fracture as “swelling, bruising and being unable to put weight on it or use it for normal movement.”

Every one of those describes a severe sprain just as well. Which means the question “is it broken” is not one you can answer at home, and it is not one you can answer by how much it hurts. It is answered by an X-ray, and that is the whole argument for being seen rather than waiting until morning to see how it looks.

Call 911 rather than driving

• A bone visible through the skin — an open fracture
• A suspected head, neck or back injury
• A suspected hip or pelvis fracture
• A limb that is pale, blue, cold or numb below the injury
• Bleeding you cannot control
• Anybody who cannot be moved safely, or who is confused or unresponsive

ACEP is specific about not moving people: “Do not move a person with a broken bone unless you are in a life-threatening situation involving further potential harm to the injured person (such as a car accident that results in a car fire), especially someone with a head, neck or back injury or a hip or pelvis fracture.”

The bar for moving somebody is a car fire. That is the example the specialty body chose, and it is worth remembering, because the instinct to get somebody up off the ground is very strong and almost always wrong.

First aid, and the instruction everybody gets backwards

Splint it in the position you found it. ACEP: “Splint the injury in the position it was found in. Splint above and below the fracture site. Pad the splints to reduce discomfort.”

Above and below — a splint that only reaches one side of the break does not stop it moving.

And do not straighten it. ACEP: “Do not try to realign the body part.”

There is one exception, and its third condition is the one that matters:

“However, if circulation is poor and the skin is turning pale, and no medical assistance is available, gently moving the injured part back into its normal position may improve circulation.”

All three conditions have to be true — including “no medical assistance is available.” On a remote trail, hours from help, that exception exists. In a city with emergency rooms open every hour, it does not, and a pale limb is a reason to call 911 immediately rather than a reason to start pulling on somebody’s leg in a car park.

If it is an open fracture: “do not try to push it back in. Use a clean, dry cloth or bandage to cover it until medical help arrives.”

Bleeding: “Stop any bleeding by gently applying pressure to the wound with a sterile bandage or clean cloth.”

Ice: “Apply ice pack to reduce swelling (except for small children and not directly on the skin).” Note both exclusions — not on bare skin, and not for small children.

Come in, even if you are not sure it is broken

Because not being sure is the normal state, and the thing that resolves it is imaging:

• You cannot put weight on it or use it normally
• There is obvious deformity — a limb or joint that looks wrong
• Swelling and bruising after an injury with real force behind it
• Pain over a bone rather than over soft tissue
• An injury in a child who will not use the limb
• An injury in an older adult after a fall, particularly to a hip, wrist or shoulder
• Pain that is not settling over a day or two

Our emergency rooms are open every hour of every day and are walk-in, with X-ray and CT in the building — so the question that brought you in gets answered during the visit rather than scheduled for later. What we can image tonight sets out what is available and when.

Go to the nearest one, and if another emergency department is closer to you, that one is the right answer tonight.

If you are unsure, come in — this list is not exhaustive and you are not expected to read your own X-ray.

Two groups where the threshold is lower

Children, because a child who will not use an arm or bear weight is telling you something even when nothing looks dramatic, and because growing bones break in patterns that are easy to underestimate.

Older adults after a fall. A hip fracture does not always announce itself, and somebody who got up and is walking stiffly can still have a serious injury. A fall in an older adult is worth assessing on its own terms, separately from whether anything looks broken.

Questions people actually ask

If I can move it, it is not broken — right? That is the commonest myth about fractures and it is not true. Being able to move a part does not rule out a break.

How long can I wait? Do not wait at all for a visible bone, deformity, a pale or numb limb, or a suspected hip, neck or back injury. For everything else, the same evening is better than the morning, because swelling makes both examination and treatment harder as hours pass.

Should I try to pop it back in? No — not a bone, not a joint, not a finger. ACEP says do not realign, and the exception requires that no medical help is available.

It has been two days and it is still swollen and sore. Get it looked at. Fractures are missed this way — the ones that do not look dramatic on day one are exactly the ones people decide to sit out.

My child fell and says it is fine but will not use their arm. Believe the arm rather than the words. That is a reason to be seen.

Will I definitely get an X-ray? That is a clinical decision made by whoever sees you, and the machine is in the building. What we will not do is tell you in advance what your visit will involve.

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Splint it as you found it, never straighten it, and call 911 for a visible bone, a pale limb, or a suspected head, neck, back, hip or pelvis injury. Both of our emergency rooms are open 24 hours a day, every day of the year, with X-ray and CT on site — walk in, no appointment and no referral. Find your nearest emergency room →

Related reading: which door do you need · what we can image tonight

Sources

43. Broken Bones — Know When To Go — American College of Emergency Physicians. https://www.emergencyphysicians.org/article/know-when-to-go/broken-bones

This article is general information, not a diagnosis. It gives no doses. If you are unsure, come in — this list is not exhaustive and you are not expected to tell a fracture from a sprain yourself. If it might be an emergency, treat it as one and call 911.