Fracture (Broken Bone)

First aid for a suspected fracture

1. Stop any bleeding with firm pressure using a clean cloth, avoiding pressing directly on protruding bone.
2. Keep the injured part still. Support it in the position found, using a sling, rolled towel or improvised splint that extends past the joints above and below the injury.
3. Apply ice wrapped in a cloth for 15 to 20 minutes to reduce swelling.
4. Elevate an injured arm or leg if it does not cause more pain.
5. Remove rings, watches and tight items near the injury before swelling increases.
6. Do not try to straighten the bone or push it back in.
7. Do not eat or drink if surgery might be needed.
8. Get medical help: call 911 for open fractures, suspected spine, hip, pelvis or thigh fractures, or signs of shock.

Symptoms of a fracture

• Pain that is worse with movement or pressure on one specific point
• Swelling and bruising
• Deformity, abnormal angle or shortening
• Inability to bear weight or use the limb normally
• A grinding or grating feeling
• A snap or crack heard at the time of injury
• Numbness or tingling if nerves are affected

Some fractures, such as small cracks, scaphoid fractures, or hip fractures in older adults, may cause surprisingly mild symptoms. For example, a fall on an outstretched hand can fracture the small bones of the wrist or palm with only tenderness and mild swelling.

Types of fractures

Common fracture sites

• Wrist: the most common fracture in adults, usually from a fall on an outstretched hand. See wrist fracture.
• Arm: forearm, elbow and upper arm fractures. See fracture of the arm.
• Hip: mostly in older adults with osteoporosis. See hip fracture.
• Ankle, collarbone, fingers, ribs and spine.

Risk factors

• Older age and falls
• Osteoporosis, especially in women after menopause
• High-impact sports and repetitive training
• Low vitamin D and calcium, low body weight
• Long-term steroid use
• Smoking and heavy alcohol use
• Cancer that has spread to bone, and other bone diseases

Diagnosis

1. Examination: checking for tenderness, deformity, skin wounds, pulses, sensation and movement.
2. X-rays: at least two views, often including the joints above and below.
3. CT scan: for complex fractures, joints and the spine or pelvis.
4. MRI: for hidden fractures (such as scaphoid, hip or stress fractures) not seen on X-ray.
5. Bone density scan (DXA) after a fragility fracture to check for osteoporosis.

Treatment

The goals are to realign the bone (reduction), hold it in place while it heals (immobilization), and restore function.

Non-surgical

• Casts: plaster or fiberglass for wrists, forearms and lower legs
• Splints and braces: for less severe fractures or while swelling settles
• Slings and boots
• Closed reduction: realigning a displaced bone without surgery, under anesthetic or sedation
• Traction: occasionally used to align bones

Surgery

• Internal fixation: plates, screws, rods or wires hold the bone pieces together
• External fixation: pins through the skin attached to an external frame, often for open or complex fractures
• Joint replacement: for some hip and shoulder fractures in older adults
• Bone grafting: for bone loss or poor healing

Open fractures need urgent antibiotics, cleaning and usually surgery, plus a tetanus booster if needed.

Pain relief

Acetaminophen (paracetamol) and short courses of anti-inflammatory or stronger pain medicines may be used. Elevation and ice help in the first days.

Rehabilitation

Physical therapy restores movement, strength and balance after immobilization.

Fracture healing time

Bones heal in stages: a blood clot forms, soft callus develops in 2 to 3 weeks, hard callus forms over 6 to 12 weeks, and the bone remodels over months to years.

Healing is slower with smoking, diabetes, poor nutrition, older age, poor blood supply, infection and some medicines.

Complications

• Compartment syndrome: dangerous pressure build-up in muscles
• Infection, especially with open fractures
• Blood clots in leg veins after leg and hip fractures
• Malunion (healing in the wrong position) and nonunion (failure to heal)
• Nerve or blood vessel injury
• Stiffness and post-traumatic arthritis
• Fat embolism after long bone fractures (rare)

Prevention

• Prevent falls with strength and balance exercise and home safety measures
• Get enough calcium and vitamin D
• Treat osteoporosis
• Wear protective gear in sports and seat belts in cars
• Increase training intensity gradually to prevent stress fractures

Frequently asked questions

How can you tell if a bone is broken?

Signs include severe pain at one spot that worsens with movement or pressure, swelling, bruising, deformity, inability to use the limb or bear weight, and sometimes a grinding feeling. Only an X-ray can confirm a fracture.

What are the main types of fractures?

Fractures are classified as closed or open, displaced or non-displaced, and by pattern: transverse, oblique, spiral, comminuted, greenstick, buckle, avulsion, compression and stress fractures. Fractures through diseased bone are called pathological fractures.

How long does a fracture take to heal?

Most fractures heal in 6 to 12 weeks. Small bones such as fingers heal in 3 to 6 weeks, while large bones like the femur take 3 to 6 months. Children heal faster. Full strength may take longer to return.

Can you walk on a broken bone?

Sometimes, especially with small foot or ankle cracks, but walking on a fracture can make it worse. If you have pain bearing weight after an injury, avoid putting weight on it and get an X-ray.

What are the symptoms of a fractured palm or hand?

A broken bone in the palm or hand causes pain, swelling and bruising over the back or palm of the hand, pain when making a fist or gripping, and sometimes a sunken knuckle or a finger that rotates when you bend it. An X-ray confirms the diagnosis.