Understanding Bone Fractures -- Diagnosis and Treatment

How Do I Know If I Have a Bone Fracture?

Doctors can usually recognize most fractures by examining the injury and taking X-rays. 

Sometimes an X-ray will not show a fracture. This is especially common with some wrist fractures, hip fractures (especially in older people), and stress fractures. In these situations, your doctor may perform other tests, such as a computed tomography (CT) scan, magnetic resonance imaging (MRI), or a bone scan.

In some cases, such as a possible wrist fracture with an initially normal X-ray, your doctor may apply a splint to immobilize the area and order a second X-ray 10 to 14 days later.

Occasionally, even after the fracture diagnosis has been made, you may need other tests (such as a CT scan, MRI, or angiogram, a special X-ray of blood vessels) to determine whether other tissues around the bone have been damaged.

If your doctor suspects a skull fracture, he or she will probably skip plain X-rays altogether and proceed directly to a CT scan, which will diagnose the fracture and any more important related injuries inside the skull, such as bleeding around the brain.

What Are the Treatments for a Bone Fracture?

A fracture often requires emergency treatment at a hospital. An example of a minor fracture that may not require emergency care is a fracture of the tip of a toe. If you think that bones may be broken in the back, neck, or hip, do not move the person; instead, call for emergency medical assistance. If the person is in shock (faint, pale, or breathing shallowly), call for emergency help, lay the person down, and raise his or her legs about eight to 12 inches unless you think leg bones may be broken.

In other cases, you may call for assistance or transport the person to the emergency room. Before transporting the person, protect the injured area to avoid further damage. For broken arm or leg bones, put a splint (made of wood, plastic, metal, or another rigid material padded with gauze) against the area to prevent movement; wrap the splint to the area using gauze. If there is bleeding, apply pressure to stop bleeding before splinting, then elevate the fracture.

Fractured bones must be set in their proper place and held there in order to heal properly. Setting a bone is called "reduction." Repositioning bone without surgery is "closed reduction." Most fractures in children are treated with closed reduction. Serious fractures may require open reduction -- repositioning using surgery. In some cases, devices such as pins, plates, screws, rods, or glue are used to hold the fracture in place. Open fractures must also be cleaned thoroughly to avoid infection.

After setting, most fractures are immobilized with a cast, splint, or, occasionally, traction to reduce pain and help healing. In most cases, medication is limited to painkillers to reduce pain. In open fractures, antibiotics are administered to prevent infection. Rehabilitation begins as soon as possible, even if the bone is in a cast. This promotes blood flow, healing, maintenance of muscle tone, and helps prevent blood clots and stiffness.