The following are fractures until proved otherwise:
impacted hip fractures - pain or walking difficulty after a fall in an elderly person
impacted fracture of humerus or distal radius - the degree of pain may be the only clue
greenstick fracture of forearm - degree of pain or typical site of pain especially in a child
wrist pain may be a scaphoid fracture (common cause of litigation against doctors because of the degree of permanent disability) - record whether there is scaphoid tenderness at the anatomical snuffbox - treat the tenderness as a fracture despite a normal Xray report
fractures of the lateral malleolus can be misdiagnosed as a sprain if swelling is extensive - if in doubt, refer
injuries in paralysed or unconscious patients or who have neuropathy, eg diabetes or MS, are very easy to miss
rib fractures occur twice as often as appear on Xrays. Treatment is usually unaffected.