Fractures and dislocations are among the most common traumatic emergencies encountered in the emergency department. A fracture refers to a break or disruption in the continuity of a bone, while a dislocation occurs when the bones forming a joint are forced out of their normal alignment. These injuries may result from road traffic accidents, falls, sports injuries, direct trauma, or high-impact forces. Because fractures and dislocations can involve significant pain, bleeding, nerve compromise, or vascular injury, prompt emergency evaluation and stabilization are essential.

Fractures vary in severity. A simple (closed) fracture involves a broken bone without skin disruption, while an open (compound) fracture involves bone protrusion through the skin, significantly increasing infection risk. Fractures may be displaced, non-displaced, comminuted (multiple fragments), or involve growth plates in children. Dislocations most commonly affect the shoulder, elbow, fingers, hip, or knee and may occur with associated fractures.

Emergency evaluation begins with structured trauma assessment. Airway, breathing, and circulation are first stabilized in cases involving high-impact injuries. Once life-threatening conditions are excluded, attention is directed to the injured limb or joint. Severe pain, swelling, deformity, bruising, inability to move the limb, or abnormal angulation suggest fracture or dislocation. In some cases, patients may hear a snapping sound at the time of injury.

A critical part of assessment involves evaluating neurovascular status distal to the injury. Circulation (pulse, skin color, capillary refill), sensation, and motor function are assessed carefully. Compromise of blood supply or nerve function constitutes an emergency requiring urgent intervention. In cases of severe swelling or tight compartments, compartment syndrome must be ruled out, as delayed treatment can result in permanent tissue damage.

Imaging studies, typically X-rays, confirm diagnosis and determine fracture type or joint displacement. In complex injuries, CT scanning may provide detailed visualization of bone fragments or joint involvement. Accurate imaging guides treatment decisions and helps determine the need for orthopedic consultation.

Immediate management focuses on pain control and immobilization. Splints are applied to stabilize the injured area and prevent further damage. Dislocated joints may require reduction procedures to restore alignment. Reduction is performed carefully under appropriate monitoring to avoid additional injury. Following realignment, immobilization devices such as casts, braces, or slings may be applied.

Open fractures require urgent antibiotic administration and surgical consultation due to high infection risk. Severe fractures with vascular compromise or unstable joint dislocations may require emergency surgical intervention. Multidisciplinary coordination with orthopedic specialists ensures timely definitive management.

Continuous monitoring is essential, particularly in high-energy injuries. Reassessment of neurovascular function is performed after immobilization or reduction to confirm restoration of circulation and nerve integrity. Early detection of complications such as compartment syndrome, infection, or vascular injury significantly improves outcomes.

Prompt emergency care of fractures and dislocations reduces pain, prevents long-term disability, and minimizes complications such as malunion, nerve damage, or chronic joint instability. Structured protocols emphasizing stabilization, imaging, neurovascular assessment, and timely specialist referral ensure optimal recovery and restoration of function.