It’s Sunday afternoon and you or a member of your family have been injured. It’s nothing life threatening, but you do have a sore extremity and you’re wondering, “Is this something that needs immediate attention or am I going to go to the emergency room and sit there for several hours on a busy weekend afternoon only to be told that this is nothing to be worried about or that I should call my doctor tomorrow. Or is this something that I can put off until tomorrow when I can see my doctor and have it evaluated and treated in a more comfortable, efficient and cost effective manner.”
These are guidelines that we use to determine the severity of an injury. They are, in fact, only guidelines. There will, of course, always be exceptions.
- Deformity is probably the most obvious sign of a problem that needs prompt attention. If something is crooked or out of alignment, you should probably proceed to the emergency room.
- Pain. All significant orthopedic injuries are painful. Generally, the more significant they are the more painful they are. However, there are some exceptions and occasionally relatively minor injuries may be fairly painful. This is not nearly as indicative of a severe injury as is a deformity.
- Swelling. Swelling is generally directly related to the severity of the injury. Without much swelling it is unlikely that an injury is severe.
- Bruising. Bruising is usually directly related to the significance of an injury. If there is not much bruising, this is probably not a significant injury.
- If the skin is intact or if there is only a scratch/abrasion, it is, in itself, not an urgent problem. However, if there is a deep laceration or opening of the skin, particularly if the bone is visible, it is an injury that needs prompt attention.
- Function. If you are able to move your extremity or if you able to walk on your leg, this generally indicates a less severe injury. However, the ability to move your fingers, or move your toes, is not a definitive indication that the extremity is not broken.
For all injuries, particularly those that are going to be evaluated in the next day or so, it is good to stay off of the extremity and not use it. Elevate it above the level of your heart and apply ice periodically for fifteen minutes every two hours. An ACE wrap or a compression wrapping is sometimes helpful, but you must be extremely careful to avoid making this too tight.