Spotted lipid sign floating on the blood to differentiate obscured open fractures from simple wound lacerations

Open fractures are not so obvious sometimes, and in the case of multiorgan injuries, they may be misdiagnosed in emergency department. Here, we report a 48-year old man with motor vehicle crash injury. There were ominous facial, vertebral, thoracic, and abdominal injuries as well as distal femoral shaft fracture and multiple skin lacerations in different parts of the body in the initial examination. On the tertiary examination, we incidentally caught an important finding showing an open fracture: oily (greasy) bleeding from the wound (Video 1, Fig. 1 and 2). We think that the characteristic of the blood, namely, the spotted lipid sign floating on the blood, is a unique and pathognomonic finding differentiating between simple wound lacerations and obscured open fractures.