How to Identify a Broken Bone

A bone fracture is a serious injury where muscles, tendons, ligaments, blood vessels, and even nerves can be harmed by the broken bone. An 'open' fracture typically involves a visible wound and is at risk of infection. A 'closed' fracture occurs when the bone breaks without any external wound, lessening the risk of infection, but still painful and in need of healing time. Within these two basic types, many other fracture variations exist.

Learn about Open Fractures. This is when a bone breaks through the skin, also known as a protruding bone fracture, and carries a risk of bacterial infection leading to complications. Carefully examine the area around the impact or suspected fracture site; if you see the bone protruding from the skin or notice any part of the bone, it is an open fracture.

Learn about Closed Fractures. As the name suggests, closed fractures occur when a bone breaks but does not penetrate the skin. In this type of fracture, the bone may remain in place, and the break can be transverse, oblique, or comminuted.

• When the bone remains in alignment, it is called a non-displaced fracture.
• An oblique fracture occurs when the break happens at an angle to the bone’s long axis.
• A comminuted fracture happens when the bone breaks into three or more pieces.
• A transverse fracture occurs when the break is straight across and perpendicular to the bone’s axis.

Recognizing a Compression Fracture. There are two types of fractures that match this criterion, but distinguishing them can be tricky. A compression fracture (also called a buckle fracture) typically happens at the ends of long bones, where one piece of bone is compressed into another. A similar injury is the compression fracture of the vertebrae, where spongy bone collapses.

• Compression fractures usually heal on their own over time, but it is important to monitor the healing process. A buckle fracture, however, requires surgical intervention.

Identifying an Incomplete Fracture. An incomplete fracture does not cause the bone to split into two separate pieces but still shows typical signs of a fracture. There are various forms of incomplete fractures:

• A greenstick fracture occurs when the bone bends but does not fully break, typically happening in children because their bones are still soft and not fully developed.
• A hairline fracture (or stress fracture) is difficult to detect via X-ray, as it presents as a thin line. These fractures may become more visible after several weeks of healing.
• A buckle fracture happens when part of the bone is pushed inward. The area where the fracture lines intersect may also collapse inward.
• Incomplete fractures show symptoms similar to complete fractures. If a limb is swollen, bruised, or bent out of shape, this is an indication of a fracture. If the pain is so intense that you cannot use your arm or leg normally, it is likely a fracture.

Understand Other Types of Bone Fractures. There are many ways to classify fractures depending on where the break occurs and how the injury happens. Understanding these types will help you recognize and avoid fractures, or seek proper treatment for them.

• A spiral fracture occurs when a twisting force is applied to a limb, causing the bone to break in a spiral pattern.
• A longitudinal fracture happens when the break runs along the length of the bone, following its long axis.
• An avulsion fracture occurs when a fragment of bone is torn away where a ligament or tendon attaches. This type of injury can happen in motorcycle accidents when the victim tries to brace themselves during a fall, often resulting in shoulder or knee injuries.

Listen for a cracking sound. If you hear a cracking noise coming from your arm or leg when you fall or experience a sudden impact, it's likely that the bone has broken. Depending on the force, severity, and angle of the break, the bone may fracture into two or more pieces. The sound you hear is the noise produced when the bone or group of bones snap due to the sudden force.

• Some sources refer to the sound of a bone breaking as a "snap".

Feel immediate, intense pain, followed by numbness and tingling. You may also experience a burning pain (except in the case of a skull fracture) that varies in intensity after the injury. Numbness or coldness may occur if the area below the fracture site is not getting enough blood. As muscles strain to stabilize the broken bone, you might notice muscle spasms as well.

Notice pain when touched, swelling, bruising, with or without bleeding. The tissues around the injury swell due to damaged blood vessels, which cause blood to leak into the surrounding area. This leads to fluid buildup, causing swelling and pain when touched.

• Blood in the tissues can show up as bruising, starting as a purple/blue color, then changing to green and yellow as the blood is reabsorbed. You might notice the bruise appearing some distance from the fracture site as blood from the damaged vessels moves there.
• External bleeding only occurs if you have an open fracture where the bone is exposed or protrudes through the skin.

Look for signs of limb deformity. Depending on the severity of the fracture, your arm or leg may appear deformed. For example, a wrist may bend at an unnatural angle, or a limb may curve unnaturally where no joint exists. In closed fractures, the internal bone structure is altered. In open fractures, the bone may protrude from the injury site.

Watch for signs of shock. When the body loses a significant amount of blood (including internal bleeding), blood pressure can drop sharply, leading to shock. In shock, the victim may appear pale, warm, or flushed, but as the blood vessels dilate too much, the skin becomes cold and clammy. The person may become quiet, disoriented, nauseous, and/or dizzy. Their breathing may start fast but slow down dangerously if too much blood is lost.

• It is common to experience shock after an injury. However, some people may have only mild shock symptoms and may not realize they have a broken bone. If you experience a significant impact and notice even one symptom of shock, you should immediately go to the hospital.

Reduced range of motion or unusual symptoms. If the fracture is near a joint, you will typically find it difficult to move the affected limb, which is a clear sign of a broken bone. You will likely experience pain when attempting to move the limb, or the injured body part may not be able to bear weight.

Seek medical attention immediately. The doctor will typically ask about the circumstances surrounding the injury to help identify the location of the potential bone fracture.

• If you’ve had a previous bone fracture, be sure to inform the doctor.
• They will likely check for other signs of a fracture such as pulse rate, skin color changes, body temperature, bleeding, swelling, or any open wounds. All this information helps the doctor quickly assess the situation and determine a treatment plan.

Get an X-ray. This is the first step when the doctor suspects or detects a fracture. X-ray images help locate the fracture and allow the doctor to analyze the extent of the injury.

• Before starting, they may ask you to remove any jewelry or metallic objects, depending on the area of your body that needs to be scanned. You might need to stand, sit, or lie down, and you will likely be asked to remain still or hold your breath while the images are taken.

Undergo a bone scan. If the X-ray doesn’t reveal the fracture, the next step is a bone scan. A bone scan differs from CT or MRI scans. The doctor will inject a small amount of radioactive material before taking images a few hours later, then track the radioactive material’s path to identify the area where bone healing is occurring.

Request a CT scan (computed tomography). A CT scan is highly effective for examining internal injuries or other physical trauma. Doctors typically use this procedure when they suspect a complex fracture or one where the bone has broken into several pieces. By combining multiple X-ray images into a single image with a computer, a 3D representation of the fracture site is created using a CT scan.

Consider an MRI (magnetic resonance imaging). MRI technology uses radiofrequency pulse waves and a computer to produce detailed images of the body. In cases of bone fractures, an MRI can offer more insight into the extent of the injury, proving especially useful in distinguishing between bone damage and injuries to cartilage or ligaments.

• Seek medical attention immediately if you believe you have broken a bone.