If a fracture is suspected, don’t move the injured area — keep it supported and apply cold for up to 20 minutes; never try to realign it yourself

Treat any limb injury as a possible fracture first; being able to stand or move does not rule it out. Keep the injured part still, supported by hand or by a stiff board in its original position, and apply cold for no more than 20 minutes at a time. Do not try to realign it yourself; if bone has pierced the skin, stop the bleeding first and do not push the bone back. An X-ray can miss a fracture. If the film looks normal but the doctor still suspects a fracture or a ligament injury, follow the doctor’s advice to come back for a repeat exam or an MRI.

Cost

No cost involved. Use a stiff board, rolled‑up magazines, or clothing as a splint. Wrap cold items in a cloth before applying them.

Benefit

The International Federation of Red Cross and Red Crescent Societies released its 2025 International First Aid Guidelines, which state that “any injury to a limb should be treated as a possible fracture” and “the only reliable way to confirm a fracture is an X‑ray; when in doubt, treat it as a fracture.” The purpose of immobilisation is “to minimise movement and pain.” Cold application “should be limited to 20 minutes at a time to reduce pain; longer exposure can damage the skin.” “For long bones such as the femur, bleeding from the bone itself can be life‑threatening.” Call emergency services if there is significant pain or swelling, signs of shock, a suspected femoral fracture, or obvious deformity of the limb. Only under two specific conditions may a fractured bone be manually realigned on site: first, when help is far away (or resources are limited) and the part of the limb below the angle appears cold and pale, or when the rescuer cannot safely immobilise it for transport; second, only if the rescuer is properly trained. For open fractures, the priority is stopping bleeding and preventing infection. But a first X-ray that shows nothing does not mean there is no fracture. The guideline on hip fracture from the UK National Institute for Health and Care Excellence (NICE) says: if the X-ray is normal but a hip fracture is still suspected, “do an MRI”; if that cannot be done within 24 hours, consider a CT. Its fracture guideline says: for a suspected wrist scaphoid fracture, “after careful physical examination, consider an MRI first”. The scaphoid is a small bone in the wrist. A Cochrane review states: “initial X-rays cannot exclude a fracture”. In the studies it included, among people whose X-rays were normal but whose doctors still suspected a scaphoid fracture, the median share with a real fracture was 20%. The American College of Radiology has an appropriateness standard for knee trauma. It says: when the X-ray shows no fracture but an occult fracture or internal joint injury is still suspected, MRI as the next step is “usually appropriate”. It also says MRI is highly accurate for occult fractures and for meniscal and ligament injuries.

Notes

This grade B rating reflects that these practices are widely accepted. There is only one older study supporting the use of traction immobilisation for femoral fractures before hospital care; its reliability is low, yet it shows modest benefits such as reduced blood loss within 24 hours, shorter hospital stays, and no meaningful difference in mortality or complications. No evidence exists regarding whether early realignment yields any advantage over simple immobilisation. Three common misconceptions should be corrected: being able to walk does not rule out a fracture; cold alone — not alternating hot and cold — is appropriate; and sprains do not “work themselves out” with movement; rest is essential. Do not smoke until the bone has healed; see Section 2, item 1 (quit smoking). Don’t expect heavy calcium supplements or bone broth to make the bone heal faster; see Section 6, item 30 (calcium after a fracture). For elderly patients with suspected fractures after a fall, refer to item 2 for handling precautions. Swelling of one leg after casting or bed rest may indicate a clot; see item 11 for details. Information on disability assessment and eligibility for a disability certificate after treatment can be found in section 24, items 9 and 10.

Sources · 5

1. International Federation of Red Cross and Red Crescent Societies (2025). International First Aid, Resuscitation and Education Guidelines 2025，第 301–302 页. ifrc.org/sites/default/files/2026-03/IFRC%20I…
2. National Institute for Health and Care Excellence (2011). Hip fracture: management. NICE guideline CG124，第 1.1.1 条. nice.org.uk/guidance/cg124/chapter/Recommenda…
3. National Institute for Health and Care Excellence (2016). Fractures (non-complex): assessment and management. NICE guideline NG38，第 1.2.3 条. nice.org.uk/guidance/ng38/chapter/Recommendat…
4. Mallee WH 等 (2015). Computed tomography versus magnetic resonance imaging versus bone scintigraphy for clinically suspected scaphoid fractures in patients with negative plain radiographs. Cochrane Database of Systematic Reviews. doi.org/10.1002/14651858.CD010023.pub2
5. Taljanovic MS 等, Expert Panel on Musculoskeletal Imaging (2019). ACR Appropriateness Criteria: Acute Trauma to the Knee，Variant 3. American College of Radiology. acsearch.acr.org/docs/69419/Narrative/