Immediate life-saving interventions
›Life threats uncommon
›If open fracture or severe infection suspected, sepsis pathway
›IV access and fluids as indicated
›If neurovascular compromise, emergent specialist involvement
›Compartment syndrome evaluation and escalation
Immobilization and Splinting
›Offloading options
›Hard sole shoe
›Mild pain and able to ambulate
›Walking boot
›Moderate pain or swelling
›Non weight bearing with crutches
›Severe pain
›High risk location
›Immobilization principles
›Avoid circumferential casting during swelling phase
›Reassess fit as swelling changes
›Neurovascular check after immobilization
›Pulses and cap refill
›Sensation in key distributions
›Not applicable
›Stress fractures typically nondisplaced
›If displaced fracture on imaging, manage as acute fracture pattern
Open fracture medications and timing
›Not applicable unless open injury
›If open injury present, open fracture pathway
›Cefazolin IV dosing per local protocol
›Add gram negative coverage for severe contamination per local protocol
›Tetanus prophylaxis per immunization status
DVT prophylaxis when relevant
›Usually not indicated
›Consider only if prolonged non weight bearing with additional VTE risk
›Prior VTE history
›Active malignancy
›Major thrombophilia
Pain control and bone health support
›Analgesia ladder
›Non opioid first line
›Acetaminophen
›Adult 650 mg to 1000 mg PO every 6 to 8 hours
›Maximum 4000 mg per 24 hours
›NSAID selective use
›Ibuprofen
›Adult 400 mg to 600 mg PO every 6 to 8 hours with food
›Avoid if renal disease or GI bleeding risk
›COX 2 selective alternative when GI risk
›Celecoxib
›Adult 100 mg to 200 mg PO twice daily
›Avoid if sulfa allergy or high CV risk
›If severe pain despite above
›Short course opioid
›Hydromorphone
›Adult 1 mg PO every 4 to 6 hours as needed
›Avoid with concurrent sedatives
›Bone health measures
›Calcium intake optimization
›Dietary sources prioritized
›Vitamin D supplementation if deficient
›Dosing per local guideline and baseline 25 hydroxyvitamin D
›Activity modification and rehab
›Impact activity cessation until pain free walking
›Cross training
›Swimming
›Cycling
›Return to run progression only after symptom free
›Incremental load increase
›No more than 10 percent weekly volume increase
›Footwear evaluation
›Replace worn shoes
›Consider orthotics if biomechanical risk