Several recent reports suggest that emergency physicians do not use adequate analgesia for patients with acutely painful conditions in the emergency department (ED). To quantify the extent of this problem, we retrospectively studied 401 patients who were treated for acute fracture over a 17-day period in eight area-wide emergency departments. Patient age, fracture site, and ED setting (urban or suburban, teaching or nonteaching) were noted. Only 121 patients (30%) received analgesics while in the ED; neither fracture site, ED setting, or patient age significantly altered analgesic dispensing practices. We conclude that inadequate use of analgesics in patients who come to the ED for treatment of acute fractures is widespread and that efforts aimed at improving the appropriate use of analgesics in the ED are warranted.