CanadiEM Frontline Primer

CanadiEM Frontline Primer – MSK – Common Fractures

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Common Wrist & Forearm Fractures


  1. Overview
  2. Colles Distal Radius Fracture
  3. Barton Distal Radius Fracture
  4. Smith Distal Radius Fracture (a.k.a. reverse Colles)

Both Bones

  1. Overview
  2. Galeazzi Fracture+Dislocation
  3. Essex Lopresti Fracture+Dislocation
  4. Radial Head Fracture
  5. Radial Neck Fracture
  6. Monteggia (“Nightstick”) Fracture+Dislocation


  1. Ulna Styloid
  2. Olecranon Fracture

Common Hand Fractures

Carpal Bones

  1. Scaphoid Fracture
  2. Trapezium Fracture
  3. Perilunate Fracture+Dislocation

Metacarpal Bones

  1. Bennet Fracture – Thumb
  2. Pseudo-Bennet Fracture+Dislocation – Thumb
  3. Rolando Fracture
  4. Boxer’s Fracture – 4th and 5th metacarpal

Humerus Fractures


  1. Proximal Humerus
  2. Mid-Humeral Fracture


  1. Humeral Condyle Fracture

Pediatric Elbow

  1. Epicondylar Fracture

Supracondylar (surgical – call pediatric orthopedic surgeon)

  1. Extension Supracondylar Fracture – Pediatrics
  2. Flexion Supracondylar Fracture – Pediatrics

Knee Fractures

  1. Tibial Plateau Fracture
  2. Patellar Fracture
  3. Segond Fracture (avulsion of the lateral tibial plateau, 75% cases associated with ACL tear)
  4. ACL Avulsion Fracture
  5. PCL Avulsion Fracture

Ankle Fractures

  1. Overview
  2. Bimalleolar Fracture
  3. Trimalleolar Fracture
  4. Pilon Fracture (Distal Tibia)

Pediatric & Adolescent Fracture Patterns

  1. Triplane Fracture – Adolescent
  2. Tillaux – Pediatric

Management of Common Fractures

Core Principles

  1. Ensure pulses are present (and hopefully symmetric) – if absent or grossly asymmetric, may need emergent reduction
  2. Ensure sensation is present – if none, may need urgent reduction
  3. Check for compartment syndrome.
  4. Splint for comfort until reduction can be completed
  5. Consider hematoma blocks if possible, since during COVID-19 we want to minimize need for sedation (which may require Bag-Valve Mask Ventilation).
  6. Recheck for compartment syndrome, pulses, and sensation following splinting and document.

General Rules of Reduction

  1. Look at contralateral anatomy for reference points.
  2. Apply analgesia, sedation, or block.
  3. Inline traction
  4. Exaggerate the initial injury (don’t go crazy with this step please).
  5. Continue inline traction, replace bones to initial location
  6. Have an assistant wrap and splint while you hold the reduction.
  7. Provide a mould with your palms not fingers as plaster hardens.


Plaster is easier for the rookie to use and is preferred by most orthopaedic residents. Prefabricated fibreglass splints will not mould well and don’t hold a reduction for long. When in doubt use plaster.

Who Needs Surgery

Here are some general rules about individual who might require urgent or emergent surgical attention:
Open Fractures
Reductions that have persistent angulation
Articular steps post-reduction greater than 2 mm
Highly comminuted fractures
Fractures where length, alignment, and rotation cannot be restored.
Patients who otherwise cannot go home.

Splinting Guides

EMRA Overview of Splinting Techniques (Click for link)

Splinting Basics from “EM in 5”

Part 1: Materials and Processes
Part 2: Upper and Lower Extremity Splints

Splint like a Pro – FOAM from EM:RAP

Sugartong Splint
Ulnar Gutter Splint
Thumb spica splint
Posterior Lower Leg Splint

Recommended reading, videos, and podcasts

Common Fractures

Would you like to read more MSK topics? Read about joint pain, or extremity soft tissue pathologies.

This is part of the CanadiEM Frontline Primer. An introduction to the primer can be found here. To return to the Primer content overview click here.

This post was copyedited and uploaded by Evan Formosa.

Afsheen Mehar

Dr. Afsheen Mehar is a resident physician at the University of Toronto in the RCPSC Emergency Medicine Training Program. Her greatest passions are medical education, POCUS and austere medicine. She holds an RDMS certification in ultrasound.

Teresa Chan

Senior Editor at CanadiEM
Emergency Physician. Medical Educator. #FOAMed Supporter, Producer and Researcher. Chief Strategy Officer of CanadiEM. Associate Professor, Division of Emergency Medicine, Department of Medicine, McMaster University.

Colm McCarthy

Colm completed his residency at McMaster University in orthopaedic surgery along with a 5 month fellowship in orthopaedic trauma surgery. He will be having a second fellowship in hip and knee reconstruction at the Brigham and Women’s Hospital. He enjoys collaborative work, medical education, and physical advocacy.