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. One should palpate the bone with one finger or a small object, starting away from the suspected fracture and moving toward it. When the child complains of discomfort, the site can be marked and the maneuver repeated starting at the other side of the fracture and moving toward it. If the bone ends displace gentle motion will produce crepitus - a grating sound and feeling as the bone ends rub against each other. The nerve and vessel status in the limb distal to the fracture must be tested, and their function also the time of the examination must be recorded for medical and legal reasons.