Bone Fracture (Broken Bone)

First aid for a broken bone

1. Call 911 for the emergency signs above.
2. Stop any bleeding with firm pressure using a clean cloth, avoiding pressing directly on a protruding bone.
3. Immobilize the injured area in the position you found it. Do not try to straighten it. Use a splint (rolled newspaper, board) padded and tied above and below the injury, or support an arm with a sling.
4. Apply ice wrapped in a cloth for up to 20 minutes.
5. Treat for shock: keep the person lying down and warm, legs raised if no leg, hip, back or head injury.
6. Remove rings and jewelry from the injured limb before swelling starts.
7. Do not give food or drink in case surgery is needed.

How to tell if a bone is broken

You cannot always tell without an X-ray. Signs that suggest a fracture:

• pain that is severe, localized to one spot on a bone, and worse with movement or pressure
• swelling and bruising, sometimes extensive
• a visible bend, bump or abnormal angle
• inability to bear weight or use the limb
• a snap or grinding sound or feeling at the time of injury
• numbness or tingling below the injury

Sprains can cause similar pain and swelling. Being able to move a limb does not rule out a fracture. Clinical rules such as the Ottawa ankle rules help doctors decide who needs an X-ray.

Types of fractures

Causes and risk factors

• falls, especially in older adults
• sports and high-energy trauma such as road crashes
• repetitive stress: running, marching, jumping (stress fractures)
• osteoporosis: the most common reason for fractures after 50, particularly wrist, spine and hip
• low vitamin D, eating disorders, low estrogen and long-term steroid use
• bone cancers and metastases
• in children, unexplained or repeated fractures may raise concern about bone disorders or abuse

Diagnosis

• Examination: the doctor checks the skin, deformity, tenderness, pulses, sensation and movement below the injury.
• X-rays: at least two views, often including the joints above and below.
• CT scan: for complex joint, spine or pelvic fractures and surgical planning.
• MRI: for hidden fractures, such as scaphoid (wrist) and hip, and stress fractures.
• Bone density scan: after a fragility fracture.

Treatment

Reduction

If the bone ends are out of line, the doctor reduces (realigns) them, either by manipulation under anesthesia or sedation (closed reduction) or during surgery (open reduction).

Immobilization

• Splints and casts (plaster or fiberglass) hold the bone still while it heals.
• Functional braces allow limited movement.
• Slings and boots for some arm and foot fractures.
• Buddy taping for some finger and toe fractures.

Surgery

Used for unstable, displaced, open or joint-surface fractures:

• plates and screws
• rods (intramedullary nails) inside long bones
• pins and wires
• external fixators for severe open fractures
• joint replacement for some hip and shoulder fractures in older adults

Pain relief and rehab

Acetaminophen and short courses of NSAIDs or other pain medicines, then physical therapy to restore strength and movement once the bone is stable.

How long do fractures take to heal?

Children heal much faster. Smoking, diabetes, poor nutrition, steroid use, infection and poor blood supply slow healing.

Complications

• Compartment syndrome: dangerous swelling within muscle compartments, causing severe pain; a surgical emergency
• Nonunion and malunion: the bone fails to heal or heals crooked
• Infection, especially with open fractures
• Fat embolism: fat droplets entering the bloodstream after long bone fractures, causing breathlessness and confusion
• Blood clots in the legs or lungs
• Nerve or blood vessel injury
• Stiffness and arthritis after joint fractures
• Growth problems after growth plate fractures in children

Living with a cast

• Keep it dry; use a cover for bathing.
• Raise the limb to reduce swelling for the first few days.
• Move fingers or toes regularly.
• Never push objects inside to scratch.
• Seek help for severe pain, numbness, color change, a bad smell or a cracked cast.

Prevention

• Build and protect bone with calcium, vitamin D and weight-bearing exercise.
• Reduce fall risk: good lighting, removing trip hazards, balance exercises, eye checks, reviewing medicines that cause dizziness.
• Use protective gear in sports, and seatbelts.
• Ask about bone density testing if you are a woman over 65, or younger with risk factors.

Frequently asked questions

How do I know if my bone is broken or just bruised?

A broken bone usually causes severe, pinpoint pain over the bone, swelling, bruising, and difficulty using or putting weight on the limb. Deformity is a strong sign. Bruises are usually less painful and allow normal use. When in doubt, get an X-ray.

Can you move a broken bone?

Sometimes. With some fractures, especially small or non-displaced ones, you can still move nearby joints, although it hurts. Being able to move or bear some weight does not rule out a fracture.

How long does it take a broken bone to heal?

Most adult fractures heal in 6 to 12 weeks, but larger bones such as the shinbone or thigh bone can take 3 to 6 months. Children's fractures heal faster. Full strength and movement may take longer, with physical therapy.

What helps broken bones heal faster?

Follow your immobilization plan, don't smoke, eat enough protein, calcium and vitamin D, control diabetes, and keep the rest of your body active. Avoid heavy alcohol use. Do not remove a cast or bear weight early unless your doctor advises.

Is a fracture the same as a break?

Yes. A fracture and a broken bone mean the same thing. Fractures range from small cracks to complete breaks in several pieces.