• Compare injured with uninjured limb
• Check distal vascular and neurological state
• Assess tendon function and consider formal exploration of wounds which may contain partially divided tendon
• X-ray all wounds caused by glass
• Compound fractures or joint injuries should all be admitted:
  • Check anti-tetanus status and treat accordingly
  • After removal of debris, a sterile pad should be applied and removed only by the Orthopaedic Registrar
  • A photo is often helpful
  • Give broad-spectrum antibacterial (anti staphylococcal) cover as soon as the patient has been stabilised
• Correct alignment and splint major fractures whenever possible and give strong analgesia
• X-rays are required in at least 2 planes. In regions with two long bones e.g. forearm and leg, both bones must be demonstrated in their entirety
• Never underestimate the value of elevation for relief of swelling and pain
• Beware of spiral fractures in the 0 - 2 age group - NAI until proven otherwise