This is not an uncommon problem in the ED and is a trap for the unwary. Childrens bony injuries are often compression/impaction injuries and these may fool the unwary clinician as there is relatively little pain and a good range of movement in the associated joints.

On the negative side this does mean that they can be difficult to spot. On the positive side they are often treated conservatively anyway (though this one was quite bad), and little harm usually occurs as a result of them being missed.

Classic sites for this error are the wrist, and shoulder.

Please remember this possibility and consider X-rays in children with bony tenderness after injury.