If you suspect a fracture, stop moving that part, support it still, use a cold pack for no more than 20 minutes, and don't try to straighten it yourself

In a real emergency, call 911 first, then read this.

Cost

Free. Find a stiff board, a rolled-up magazine or some clothing for support. Put cold things on over a layer of cloth.

What you get

The International Federation of Red Cross and Red Crescent Societies published the 2025 international first aid guidelines. They say "any injury to a hand or foot should first be treated as a possible fracture." They also say "the only accurate way to confirm a fracture is an X-ray. If unsure, treat it as a fracture." The purpose of immobilizing is "to minimize movement and pain." A cold pack is used "for at most 20 minutes in a row, which can ease pain; colder for longer may damage the skin." "With injuries to long bones such as the femur, the bleeding from the bone itself may be fatal." Call for emergency help when pain or swelling is marked, there are signs of shock, the femur (thigh bone) is broken, or the limb is clearly out of position. For a fracture bent at an angle, two conditions must both hold before considering moving the bone back into place at the scene (reduction). One is "a remote location (or limited conditions), and the limb below the angle is cold and pale, or the first aider cannot immobilize it well enough to move the person." The other is that the rescuer is trained. For an open fracture (a broken bone pushing through the skin), the priorities are stopping the bleeding and preventing infection. But a first X-ray that shows nothing does not mean there is no fracture. The UK National Institute for Health and Care Excellence (NICE) hip fracture guideline says: where the X-ray is normal but a hip fracture is still suspected, "do an MRI." If it can't be done within 24 hours, consider a CT. Its fracture guideline says: for a suspected fracture of the scaphoid in the wrist, "after a careful physical exam, consider an MRI first." The scaphoid is a small bone in the wrist. A Cochrane literature review says: "an initial X-ray cannot rule out a fracture." In the studies it covered, among people with a normal X-ray whom doctors still suspected of a scaphoid fracture, the median share who really had a fracture was 20%. The American College of Radiology has a set of criteria for knee trauma. It says: where an X-ray shows no fracture but a hidden fracture or internal joint injury is still suspected, the next step of an MRI is "usually appropriate." It also says MRI is very accurate for hidden fractures and for meniscus and ligament injuries

Notes

Graded B because these are accepted practices. Applying traction to a femur (thigh bone) fracture before reaching the hospital rests on only one study of old records, and the evidence is of very low certainty. The result was less blood given in the first 24 hours and shorter hospital stays, with differences in deaths and complications too small to tell. As for whether to reduce first (put the bone back in place) or splint it as it lies, no evidence was found at all. Three common misunderstandings to correct: being able to stand and walk does not mean there is no fracture; use cold only, no heat, and don't alternate cold and heat; a sprain does not "get better once you move it," so rest it first. Don't smoke before the bone has healed; see §2.1 (quit smoking). Don't expect heavy calcium supplements or bone broth to make bone grow faster; see §6.30 (heavy calcium after a fracture). For the rule against moving an older person who may have a fracture after a fall, see §13.2. If one leg swells after a cast or bed rest, watch for a clot; see §13.11. For whether to get a disability assessment or a disability certificate after treatment, see §24.9, §24.10.

Evidence grade

B : Supported by research but without a precise number, or based on small or single studies.

Sources

1. International Federation of Red Cross and Red Crescent Societies (2025). International First Aid, Resuscitation and Education Guidelines 2025，第 301–302 页. https://www.ifrc.org/sites/default/files/2026-03/IFRC%20International%20First%20Aid,%20Resuscitation%20and%20Education%20Guidelines%202025.pdf
2. National Institute for Health and Care Excellence (2011). Hip fracture: management. NICE guideline CG124，第 1.1.1 条. https://www.nice.org.uk/guidance/cg124/chapter/Recommendations
3. National Institute for Health and Care Excellence (2016). Fractures (non-complex): assessment and management. NICE guideline NG38，第 1.2.3 条. https://www.nice.org.uk/guidance/ng38/chapter/Recommendations
4. Mallee WH 等 (2015). Computed tomography versus magnetic resonance imaging versus bone scintigraphy for clinically suspected scaphoid fractures in patients with negative plain radiographs. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD010023.pub2
5. Taljanovic MS 等, Expert Panel on Musculoskeletal Imaging (2019). ACR Appropriateness Criteria: Acute Trauma to the Knee，Variant 3. American College of Radiology. https://acsearch.acr.org/docs/69419/Narrative/

Translated from the Chinese original. Original book, section 13, tip 41. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer