Thorough neurovascular examination of all extremities: These patients have a high rate of missed injury, both due to distracting injuries and because of limited communication due to altered mental status from a state of shock.

Skin examination: The skin overlying any fracture should be evaluated for dermal violation, if present; any laceration violating the dermis should be considered an open fracture until deemed otherwise.

Concomitant injuries: These patients are at high risk for intracranial, intrathoracic, and intra-abdominal injuries.

When any of the orthopaedic emergencies are present (See Chapter 5).