The examination of an apprehensive child may tax the ingenuity of the examiner, and radiographs may be more difficult to interpret. The physician should suspect fracture when there is a history of injury with immediate pain and loss of function of the part. Bone and periosteum are well innervated, and these nerve fibers transmit pain. Unlike adults who fail to use an extremity for many reasons, when a child will not mover apart, suspect fracture or infection. Swelling may or may not be present, especially immediately.
Bone is highly vascular and bleeds profusely when broken.
In children the thick, strong tube of periosteum, if not torn, may confine bleeding, and especially in a deeply buried bone such as a femur, swelling may not be obvious. A nondisplaced fracture bleeds little. The presence of deformity depends upon the amount of angulation and displacement of the fracture. Obvious deformity makes the diagnosis easier. Point tenderness , a pathognomonic sign of a bone lesion, can be used to localize the fracture.