BACKGROUND: Information is limited regarding the costs associated with long bone fractures in a working age population, particularly around lost productivity.    OBJECTIVES: To estimate the direct and indirect costs associated with long bone fractures in a working age population.  METHODS: Adult patients with long bone fractures between 1/1/2001 and 12/31/2008 were identified in the MarketScan Commercial and Health Productivity Management Databases.  Patient costs and utilization, including workplace absenteeism and short term disability, were compared in the 6 months before and after a fracture.  Observed incremental costs (i.e., the difference in costs before and after a fracture) were reported in mutually exclusive fracture cohorts.  Multivariate adjusted costs were calculated using GLM with fracture type as dummy variables.  RESULTS: A total of 208,094 patients met the study inclusion criteria for the following fracture types: tibia shaft (n=49,839), radius (n=97,585), hip (n=11,585), femur (n=6,788), humerus (n=29,884) and multiple fractures (n=12,413).  The average observed direct costs in the 6-months prior to a long bone fracture were as follows: radius ($3,291), tibia ($4,175), multiple fractures ($5,291), humerus ($5,457), femur ($8,147) and hip ($12,923).  The average incremental direct cost increase in the 6-months following a fracture ranged from $5,707 for radius fractures to $18,965 for femur fractures; observed incremental direct medical costs were $39,041 for patients with multiple fractures.  Incremental observed absenteeism costs ranged from $886 for radius fractures to $2,478 for femur fractures and $3,337 for multiple fractures while incremental short term disability costs ranged from $1,820 for radius fractures to $4,131 for hip fractures and $6,177 for multiple fractures.  Multivariate adjustment yielded substantively similar results for both direct and indirect costs outcomes.  CONCLUSIONS: Long bone fractures are costly, both in terms of direct medical costs and lost productivity; lost productivity represents a significant portion of the burden of long bone fractures.