Are there any open wounds? These injuries are often high-energy trauma.

Are there any associated injuries?

Is there a current concern for compartment syndrome?

Ensure leg is stabilized and iced immediately.

X-rays of the knee, femur, and hip to evaluate femur.

Trauma series (X-ray chest and pelvis) appropriate if high energy.

CT hip (see Imaging, below).

Be prepared for conscious sedation if traction needed (see Reduction).

Open fractures: should be irrigated and stabilized in ED and receive antibiotics (will require formal irrigation and debridement in OR).

Pain out of proportion/paresthesia: compartment syndrome requires emergent fasciotomy in OR.

Vascular compromise: altered pulse exam or ABI<0.8 (or 0.2 less than contralateral) is suggestive of vascular injury.