Orthopaedics Revision Guide ✅

🦴 Orthopaedics is anatomy, mechanics, pain, function and neurovascular safety. In every limb injury, ask: is the limb perfused?, are nerves working?, is the fracture open?, is there compartment syndrome?, and does this need reduction, antibiotics, splintage, surgery or rehabilitation? For exams and ward work, the key orthopaedic habit is simple: look at the patient, examine the joint above and below, document neurovascular status before and after intervention, immobilise safely, and escalate time-critical pathology early.

✅ 1. Core Orthopaedic Principles

🔍 1.1 Orthopaedic History

• Mechanism: fall, twist, crush, high-energy trauma, sports injury, road traffic collision.
• Timing: acute trauma, gradual onset, recurrent, night pain, morning stiffness.
• Pain: site, radiation, severity, mechanical vs inflammatory, rest/night pain.
• Function: weight-bearing, walking distance, stairs, work, sport, ADLs.
• Neurovascular symptoms: numbness, tingling, weakness, cold limb, colour change.
• Infection risk: fever, wounds, surgery, prosthesis, diabetes, immunosuppression, IV drug use.
• Bone health: low-trauma fracture, steroid use, menopause, alcohol, smoking, previous fractures.
• Patient factors: frailty, cognition, anticoagulation, occupation, hand dominance, baseline mobility.

🩺 1.2 Orthopaedic Examination

• Look: deformity, swelling, bruising, wounds, scars, erythema, muscle wasting, posture and gait.
• Feel: tenderness, warmth, effusion, bony landmarks, pulses, capillary refill, compartments.
• Move: active and passive range; avoid forcing movement if fracture/dislocation suspected.
• Function: weight-bearing, grip, gait, transfers, straight leg raise or functional task.
• Neurovascular: sensation, motor function, pulses, capillary refill, skin temperature.
• Joint above and below: fractures and referred pain can mislead.

🧠 Exam pearl: In trauma, neurovascular status is not optional. Document it before and after reduction, splinting or surgery.

🧪 1.3 Imaging Principles

• X-ray the joint above and below long-bone fractures.
• Use two views at 90 degrees where possible.
• Compare with opposite side in children if growth plate anatomy is unclear.
• CT helps define complex intra-articular fractures, pelvic trauma and surgical planning.
• MRI is useful for occult fractures, soft tissue injury, osteomyelitis, avascular necrosis, cord/cauda equina pathology.
• Ultrasound can assess effusions, tendons and guide aspiration/injection.

🦴 2. Fracture Basics

NICE NG38 covers non-complex fractures that can usually be treated in the emergency department or orthopaedic clinic, while NICE NG37 covers complex fractures including pelvic fractures, open fractures and severe ankle/pilon fractures. Hip fracture management is covered by NICE CG124.

📚 2.1 Describing a Fracture

• Bone: which bone and which side.
• Location: proximal, shaft, distal; intra-articular or extra-articular.
• Pattern: transverse, oblique, spiral, comminuted, segmental, impacted, avulsion.
• Displacement: translation, angulation, shortening, rotation.
• Open or closed: any wound near fracture is open until proven otherwise.
• Neurovascular status: pulses, cap refill, sensation, motor.
• Associated injuries: dislocation, ligament injury, compartment syndrome, skin compromise.

🧱 2.2 Fracture Healing

• Inflammation: haematoma and inflammatory cells initiate repair.
• Soft callus: fibrocartilaginous bridge forms.
• Hard callus: woven bone replaces soft callus.
• Remodelling: bone adapts over months to years according to load.
• Healing is impaired by smoking, diabetes, infection, poor blood supply, malnutrition, steroids and severe soft tissue injury.

⚙️ 2.3 Fracture Management Principles

⚠️ Safety pearl: Splints and casts can cause harm. Always give advice about increasing pain, numbness, swelling, colour change and tightness — these may indicate compartment syndrome or vascular compromise.

🚨 3. Open Fractures and Complex Trauma

🩸 3.1 Open Fracture Recognition

• An open fracture is a fracture with communication between fracture haematoma and external environment.
• Any wound near a fracture should be treated as open until proven otherwise.
• Do not probe the wound in the ED.
• Assess contamination, soft tissue loss, vascular injury, nerve injury and compartment risk.
• Take photographs if local pathway supports this, then cover wound with sterile saline-soaked dressing/occlusive dressing.
• Give IV antibiotics and tetanus assessment early according to local/BOAST guidance.
• Realign gross deformity and splint after neurovascular assessment.

🔪 3.2 Open Fracture Management Principles

• ABCDE and haemorrhage control first.
• Analgesia and early IV antibiotics.
• Remove gross contamination only if easily removable; avoid repeated wound exposure.
• Splint the limb and elevate if appropriate.
• Urgent orthopaedic/plastic surgery involvement for debridement, stabilisation and soft tissue cover.
• Open fractures of long bones, hindfoot or midfoot usually require specialist trauma network management.
• Definitive fixation and soft tissue cover should follow BOAST/local trauma standards.

🩸 3.3 Pelvic Fractures

• Pelvic fractures can cause massive occult haemorrhage.
• Suspect in high-energy trauma, pelvic pain, leg length discrepancy, bruising, perineal/scrotal haematoma or shock.
• Avoid repeated springing/compression of pelvis — it can worsen bleeding.
• Apply pelvic binder at greater trochanter level if unstable pelvic injury suspected.
• Look for urethral injury: blood at meatus, high-riding prostate, perineal bruising, inability to void.
• Management may require blood products, interventional radiology, external fixation or pelvic packing.

🚨 Exam pearl: In trauma, shock is haemorrhage until proven otherwise — and the pelvis can hide a large amount of blood.

🚨 4. Compartment Syndrome

Compartment syndrome occurs when pressure rises within a closed fascial compartment, compromising perfusion and causing muscle and nerve ischaemia. It is limb-threatening and time-critical.

🔥 4.1 Causes

• Tibial shaft fracture — classic association.
• Forearm fractures.
• Crush injury.
• Tight cast or dressing.
• Burns and circumferential eschar.
• Reperfusion after vascular injury.
• Bleeding into compartment, especially anticoagulated patients.

🚩 4.2 Clinical Features

• Severe pain out of proportion to injury.
• Pain on passive stretch of muscles in the compartment.
• Tense swollen compartment.
• Paraesthesia or reduced sensation.
• Weakness may occur as nerves become ischaemic.
• Pallor, pulselessness and paralysis are late signs.
• Analgesia-resistant pain after fracture fixation or casting is concerning.

🧯 4.3 Management

• Remove constrictive dressings/casts immediately.
• Keep limb at heart level — not high elevation if perfusion is compromised.
• Urgent senior orthopaedic review.
• Do not delay fasciotomy when clinical suspicion is high.
• Compartment pressure measurement can help uncertain cases but should not delay treatment in clear cases.

🚨 Safety pearl: Pulses can still be present in compartment syndrome. Waiting for pulselessness is waiting too long.

🧩 5. Dislocations

🦾 5.1 General Dislocation Principles

• Assess and document neurovascular status before and after reduction.
• Obtain X-ray before reduction unless vascular compromise or time-critical situation requires immediate action.
• Provide appropriate analgesia/sedation and monitoring.
• Post-reduction X-ray confirms position and associated fracture.
• Immobilise and arrange follow-up/rehabilitation.

🦾 5.2 Shoulder Dislocation

• Anterior shoulder dislocation is most common.
• Mechanism: abduction, external rotation and extension.
• Appearance: squared-off shoulder, arm held abducted/external rotation.
• Check axillary nerve: sensation over regimental badge area and deltoid function.
• Associated injuries: greater tuberosity fracture, Bankart lesion, Hill-Sachs lesion, rotator cuff tear in older patients.
• Recurrent instability is common in younger patients.

🦵 5.3 Hip Dislocation

• Usually high-energy trauma or prosthetic hip dislocation.
• Posterior hip dislocation: shortened, flexed, adducted, internally rotated leg.
• Check sciatic nerve function.
• Urgent reduction reduces risk of avascular necrosis of femoral head.
• Look for acetabular fracture and other high-energy injuries.

🦿 5.4 Knee Dislocation

• True tibiofemoral knee dislocation may spontaneously reduce before assessment.
• High risk of popliteal artery injury and common peroneal nerve injury.
• Check pulses, capillary refill, ankle-brachial pressure index and neuro exam.
• Vascular imaging/surgical input if abnormal or high concern.

💪 5.5 Elbow and Patella Dislocation

• Elbow dislocation: check median, ulnar, radial nerve and brachial/radial pulses.
• Patellar dislocation: usually lateral; check for osteochondral fracture after reduction.
• Rehabilitation focuses on range, strength and instability prevention.

🦴 6. Upper Limb Orthopaedics

🦴 6.1 Clavicle and AC Joint

• Clavicle fractures are common after fall onto shoulder or outstretched hand.
• Most midshaft fractures are managed conservatively with sling and analgesia.
• Red flags: skin tenting, open fracture, neurovascular injury, floating shoulder, severe displacement/shortening in selected cases.
• AC joint injury causes pain at top of shoulder after direct blow; severity ranges from sprain to complete disruption.

🦾 6.2 Proximal Humerus and Humeral Shaft

• Proximal humerus fractures are common in older osteoporotic patients.
• Assess axillary nerve and vascular status.
• Humeral shaft fractures risk radial nerve palsy — wrist drop and sensory loss over dorsal first web space.
• Many humeral shaft fractures can be treated with functional bracing if alignment acceptable.

💪 6.3 Elbow Fractures

• Supracondylar fractures in children risk brachial artery and median/anterior interosseous nerve injury.
• Olecranon fractures impair active elbow extension.
• Radial head fractures cause lateral elbow pain and reduced pronation/supination.
• Always check for distal radioulnar and wrist injuries with forearm/elbow trauma.

✋ 6.4 Wrist and Hand

🧠 Exam pearl: In hand injuries, rotation is more important than small degrees of angulation. Ask the patient to make a fist and look for finger overlap/scissoring.

🦵 7. Lower Limb Orthopaedics

🦴 7.1 Hip Fracture

NICE CG124 covers hip fracture management from admission through surgery, rehabilitation and discharge planning. It was last updated in January 2023.

• Typical presentation: older patient after fall with hip/groin pain, inability to weight bear, shortened externally rotated leg.
• Impacted intracapsular fractures may allow some weight-bearing and minimal deformity.
• Initial management: analgesia, X-ray pelvis/hip, bloods, ECG, hydration, pressure care, delirium prevention, fascia iliaca block where appropriate.
• MRI or CT may be needed if X-ray negative but clinical suspicion remains.
• Surgery is usually early once medically optimised; unnecessary delay increases complications.
• Intracapsular fractures risk avascular necrosis because retinacular blood supply to femoral head is disrupted.
• Extracapsular fractures are usually treated with fixation such as dynamic hip screw or intramedullary nail depending on pattern.
• Post-op priorities: mobilisation, VTE prophylaxis, analgesia, nutrition, delirium prevention, osteoporosis/falls assessment.

🦵 7.2 Femoral Shaft and Distal Femur

• Femoral shaft fractures can cause major blood loss into the thigh.
• Usually high-energy in young adults and low-energy fragility/periprosthetic in older adults.
• Initial management: ABCDE, analgesia, traction/splintage, neurovascular assessment, blood loss awareness.
• Definitive management often involves intramedullary nailing or fixation.

🦿 7.3 Tibia and Fibula

• Tibial shaft fractures are subcutaneous and commonly open.
• High risk of compartment syndrome.
• Assess skin, compartments, pulses and peroneal/tibial nerve function.
• Management depends on open/closed status, displacement, stability and soft tissue injury.

🦶 7.4 Ankle Fractures

• Assess medial/lateral malleolar tenderness, swelling, deformity and neurovascular status.
• Ottawa ankle rules help decide when X-rays are needed in selected injuries.
• Unstable ankle fractures involve talar shift, syndesmotic injury, bimalleolar/trimalleolar patterns or posterior malleolus involvement.
• Check skin carefully — ankle fracture-dislocations can threaten skin quickly.
• Reduce grossly deformed ankle fracture-dislocations urgently after neurovascular check.

🦶 7.5 Foot Injuries

• Calcaneal fractures occur after fall from height; check spine for associated injury.
• Lisfranc injury causes midfoot pain/swelling and plantar bruising; missed injuries cause chronic disability.
• Fifth metatarsal base fractures include avulsion and Jones fractures with different healing risks.
• Diabetic foot injuries/infections need vascular, neuropathy and infection assessment.

🦠 8. Orthopaedic Infection

🔥 8.1 Septic Arthritis

• Hot swollen painful joint with restricted movement is septic arthritis until proven otherwise.
• Risk factors: prosthetic joint, rheumatoid arthritis, diabetes, immunosuppression, IV drug use, older age.
• Common organisms: Staphylococcus aureus, streptococci; gonococcal arthritis in sexually active young adults.
• Investigations: FBC, CRP, blood cultures, X-ray, urgent joint aspiration before antibiotics if safe and not delaying care.
• Synovial fluid: Gram stain, culture, white cell count, crystals.
• Crystals do not exclude infection.
• Management: urgent antibiotics and joint washout/drainage with orthopaedic input.

🦴 8.2 Osteomyelitis

• Bone infection may be haematogenous, from contiguous spread or after trauma/surgery.
• Risk factors: diabetes, peripheral vascular disease, foot ulcers, trauma, prosthetic material, IV drug use.
• Features: bone pain, fever, local swelling/warmth, raised inflammatory markers; chronic disease may be subtle.
• MRI is highly useful for early diagnosis.
• Bone biopsy/deep culture helps target antibiotics.
• Management often requires prolonged antibiotics and sometimes surgical debridement.

🦿 8.3 Prosthetic Joint Infection

• May present with pain, swelling, warmth, wound leakage, sinus, fever or loosening.
• Early infections occur soon after surgery; late infections may be haematogenous.
• Do not start antibiotics before aspiration/cultures in stable patients unless septic.
• Management may include debridement and implant retention, one-stage/two-stage revision or suppressive antibiotics depending on timing/organism/patient.

🧒 8.4 Limping Child: Infection Focus

• Septic arthritis in children is an emergency due to rapid cartilage destruction.
• Red flags: fever, inability to weight bear, severe pain, reduced range of movement, high CRP/WCC.
• Hip infection may present as knee pain.
• Osteomyelitis may present with limp, focal bone tenderness and systemic symptoms.

🚨 Safety pearl: A hot swollen joint is not “gout” until infection has been considered. Aspirate if septic arthritis is possible.

🦴 9. Arthritis and Common Joint Disease

🦵 9.1 Osteoarthritis

• Degenerative joint disease involving cartilage, subchondral bone, synovium and whole-joint biomechanics.
• Pain is mechanical: worse with activity, better with rest; morning stiffness usually brief.
• Common sites: knees, hips, hands, spine, first MTP.
• Signs: bony enlargement, crepitus, reduced range, deformity, joint-line tenderness.
• X-ray: joint space narrowing, osteophytes, subchondral sclerosis, cysts.
• Management: education, exercise, weight loss if appropriate, physiotherapy, analgesia, topical NSAIDs, steroid injections in selected cases, joint replacement if severe functional limitation.

🔥 9.2 Inflammatory Arthritis

• Inflammatory pain: morning stiffness >30–60 minutes, improves with activity, swelling/warmth.
• Rheumatoid arthritis: symmetrical small joint synovitis, MCP/PIP/wrist involvement, fatigue.
• Spondyloarthritis: inflammatory back pain, enthesitis, dactylitis, psoriasis, IBD, uveitis.
• Early rheumatology referral matters because disease-modifying therapy prevents damage.

🧪 9.3 Crystal Arthritis

• Gout: monosodium urate crystals; acute red hot painful joint, often first MTP.
• Pseudogout/CPPD: calcium pyrophosphate; knees/wrists common, chondrocalcinosis.
• Joint aspiration confirms crystals and excludes infection.
• Acute management: NSAID, colchicine or steroid depending on patient factors.
• Long-term gout management: urate-lowering therapy and risk factor modification when indicated.

🦾 9.4 Joint Replacement

• Indications: severe pain and functional limitation despite conservative management.
• Hip replacement helps OA, fracture and avascular necrosis; knee replacement helps severe OA/inflammatory destruction.
• Complications: infection, dislocation, loosening, periprosthetic fracture, VTE, nerve injury, leg length discrepancy.
• Post-op rehabilitation and infection prevention are crucial.

🧒 10. Paediatric Orthopaedics

🌱 10.1 Growth Plate Injuries

• Children’s bones fail through growth plates, which are weaker than ligaments.
• Salter-Harris classification describes physeal injuries.
• Growth plate damage can cause growth arrest, deformity or limb length discrepancy.
• Do not assume “sprain” in a child with focal bony tenderness over a physis.

👶 10.2 Developmental Dysplasia of the Hip

• Abnormal development of acetabulum/femoral head relationship.
• Risk factors: breech, female sex, family history, oligohydramnios, firstborn.
• Examination: Barlow and Ortolani in newborns; asymmetrical creases/limited abduction later.
• Ultrasound is used for screening high-risk infants or abnormal exam depending on pathway.
• Treatment: Pavlik harness early; surgery/casting if late or failed conservative treatment.

🦵 10.3 Perthes Disease

• Idiopathic avascular necrosis of femoral head in children, usually boys aged 4–8.
• Presentation: limp, hip/groin/thigh/knee pain, reduced hip abduction/internal rotation.
• X-ray may show femoral head sclerosis, fragmentation and collapse.
• Management aims to maintain femoral head containment and range of movement; orthopaedic follow-up is needed.

🧍 10.4 Slipped Upper Femoral Epiphysis

• Displacement of femoral head epiphysis relative to neck through growth plate.
• Typical patient: overweight adolescent, but can occur with endocrine disease.
• Symptoms: hip, groin, thigh or knee pain; limp; externally rotated leg.
• Reduced internal rotation is a key sign.
• Do not force movement; keep non-weight-bearing and refer urgently.
• Complications: avascular necrosis, chondrolysis, early OA.

🧒 10.5 Limping Child

🧠 Exam pearl: Hip pathology in children can present as knee pain. Always examine the hip in a child with unexplained knee pain or limp.

🧠 11. Spine and Back Pain

🔍 11.1 Mechanical Back Pain

• Very common and usually improves with time, activity and simple analgesia.
• Features: pain related to movement/posture, no systemic symptoms, no progressive neurology.
• Encourage staying active, avoiding bed rest, physiotherapy and work/function focus.
• Routine imaging is not needed for uncomplicated non-specific low back pain.

🚨 11.2 Cauda Equina Syndrome

• Compression of lumbosacral nerve roots causing bladder, bowel, sexual and saddle sensory dysfunction.
• Red flags: urinary retention, reduced urinary sensation, saddle anaesthesia, faecal incontinence, bilateral sciatica, progressive neurological deficit.
• Requires emergency MRI and spinal surgical referral.
• Normal anal tone does not reliably exclude cauda equina.

🧱 11.3 Spinal Cord Compression

• Causes: metastatic cancer, epidural abscess, trauma, disc disease, haematoma.
• Features: back pain, limb weakness, sensory level, hyperreflexia, gait disturbance, bladder/bowel dysfunction.
• Malignant spinal cord compression often causes night/rest pain and progressive symptoms.
• Urgent MRI whole spine and specialist input are needed.

🦠 11.4 Spinal Infection

• Discitis/vertebral osteomyelitis presents with severe back pain, fever may be absent.
• Risk factors: diabetes, immunosuppression, IV drug use, bacteraemia, recent spinal procedure.
• Epidural abscess can cause back pain, fever and neurological deficit, but full triad is often absent.
• MRI is investigation of choice; blood cultures and prolonged antibiotics are needed.

🏹 11.5 Radiculopathy

• Nerve root compression causes dermatomal pain, sensory symptoms and myotomal weakness.
• Sciatica commonly follows L5 or S1 distribution.
• Straight leg raise may reproduce radicular pain.
• Progressive motor weakness or cauda equina symptoms require urgent assessment.

🦴 12. Osteoporosis and Fragility Fractures

🧬 12.1 Osteoporosis Basics

• Osteoporosis is reduced bone strength increasing fragility fracture risk.
• Fragility fracture occurs from low-energy trauma, such as fall from standing height or less.
• Common sites: hip, vertebra, distal radius, proximal humerus.
• Risk factors: age, female sex, menopause, previous fracture, steroids, low BMI, smoking, alcohol, rheumatoid arthritis, parental hip fracture.
• Secondary causes: hyperthyroidism, hyperparathyroidism, coeliac disease, myeloma, CKD, hypogonadism, malabsorption.

🧪 12.2 Assessment

• Use fracture risk tools such as FRAX/QFracture according to local pathway.
• DEXA measures bone mineral density and gives T-score.
• Consider bloods for secondary causes: calcium, vitamin D, ALP, renal, thyroid, FBC, myeloma screen if indicated.
• Vertebral fracture may present with height loss, kyphosis or acute back pain.

💊 12.3 Management

• Falls prevention, strength/balance training and home hazard review.
• Calcium and vitamin D optimisation where appropriate.
• Bisphosphonates are common first-line antiresorptive therapy.
• Denosumab, teriparatide or other specialist options may be used in selected patients.
• Dental health and atypical femur fracture/osteonecrosis risk should be discussed for antiresorptives.
• Hip fracture should trigger secondary prevention assessment.

📌 Clinical pearl: A fragility fracture is a diagnosis of bone vulnerability, not just an accident. Treat the fracture and the future fracture risk.

🦿 13. Sports and Soft Tissue Injuries

🦵 13.1 Ligament Injuries

• ACL injury: pivoting injury, pop, rapid haemarthrosis, instability.
• PCL injury: dashboard injury or fall onto flexed knee.
• MCL injury: valgus force; medial knee pain/laxity.
• Meniscal tear: twisting injury, joint-line pain, locking/catching.
• Achilles rupture: sudden calf pain like being kicked, weak plantarflexion, positive Simmonds/Thompson test.

🦾 13.2 Shoulder Soft Tissue

• Rotator cuff disease: painful arc, weakness, night pain.
• Rotator cuff tear: weakness after trauma, especially older patients after shoulder dislocation.
• Frozen shoulder: painful global restriction of active and passive movement, diabetes association.
• Impingement is a clinical syndrome; consider cuff pathology, bursitis, AC joint and cervical referral.

💪 13.3 Tendinopathy

• Tendinopathy is load-related tendon pain and dysfunction rather than simple inflammation.
• Examples: tennis elbow, Achilles tendinopathy, patellar tendinopathy, rotator cuff tendinopathy.
• Management: load modification, progressive strengthening, physiotherapy, analgesia; steroid injections have site-specific risks.

🦶 13.4 Ankle Sprain

• Most involve lateral ligament complex after inversion injury.
• Assess Ottawa ankle rules for X-ray need.
• Management: protection, optimal loading, ice/compression/elevation, rehab, proprioception training.
• Persistent pain/swelling may indicate fracture, syndesmotic injury, osteochondral lesion or tendon injury.

🧬 14. Bone Tumours and Red Flags

🚩 14.1 Bone Pain Red Flags

• Night pain or rest pain.
• Persistent progressive pain not explained by injury.
• Systemic symptoms: weight loss, fever, night sweats.
• Palpable mass or swelling.
• Pathological fracture.
• History of cancer.
• Neurological symptoms or spinal red flags.

🦴 14.2 Primary Bone Tumours

• Osteosarcoma: adolescents/young adults, metaphysis around knee, painful swelling.
• Ewing sarcoma: children/adolescents, diaphysis, pain, fever, systemic symptoms; can mimic infection.
• Chondrosarcoma: adults, pelvis/shoulder, cartilage tumour.
• Refer suspected bone sarcoma urgently to specialist sarcoma pathway; biopsy should be planned by sarcoma team.

🎗️ 14.3 Metastatic Bone Disease

• Common primaries: breast, prostate, lung, kidney, thyroid, myeloma.
• Complications: pain, pathological fracture, hypercalcaemia, spinal cord compression.
• Management: analgesia, radiotherapy, systemic cancer treatment, bisphosphonates/denosumab, orthopaedic stabilisation if fracture risk.
• Mirels score may guide prophylactic fixation decisions in long-bone metastases.

🚨 15. Orthopaedic Emergencies

📚 16. OSCE / Exam Pearls

• Always examine and document neurovascular status before and after reduction or splinting.
• Any wound near a fracture is an open fracture until proven otherwise.
• Pain out of proportion suggests compartment syndrome, necrotising infection or ischaemia.
• Pulses can be present in compartment syndrome.
• Hot swollen joint is septic arthritis until proven otherwise.
• Crystals in joint fluid do not exclude infection.
• Children with hip disease can present with knee pain.
• SUFE: overweight adolescent with hip/groin/knee pain and externally rotated leg.
• Perthes: younger child with limp and reduced hip movement.
• Scaphoid fracture can be X-ray occult; snuffbox tenderness matters.
• Back pain with bladder/saddle symptoms is cauda equina until proven otherwise.
• Fragility fracture should trigger osteoporosis and falls assessment.

📌 17. Quick Differentials Table

📚 References

• NICE. Fractures (non-complex): assessment and management. NG38.
• NICE. Fractures (complex): assessment and management. NG37.
• NICE. Hip fracture: management. CG124.
• British Orthopaedic Association Standards for Trauma (BOAST), including open fracture standards.
• NICE. Osteoporosis: assessing the risk of fragility fracture. CG146.
• NICE. Osteoarthritis in over 16s: diagnosis and management. NG226.
• Local orthopaedic, trauma, spinal, paediatric orthopaedic, open fracture, VTE, antimicrobial and rehabilitation pathways should always be followed.

⚠️ Disclaimer

This article is for medical education and exam revision. Clinical decisions should follow current local orthopaedic, trauma, paediatric, spinal, antimicrobial, imaging, VTE, fracture clinic, rehabilitation and operative pathways, formularies, senior advice, NICE guidance and BOAST standards. Orthopaedic emergencies such as compartment syndrome, open fractures, septic arthritis, cauda equina syndrome, spinal cord compression, neurovascular compromise, knee dislocation and necrotising fasciitis require urgent senior input.