Fracture (cont.)

Medical Author:
Medical Editor:

How is a bone fracture diagnosed?

The story of the injury is often key to proper diagnosis. Where, when, and why did the injury occur? Did the person trip and fall, or did they pass out before the fall? Are there other injuries that take precedence over the fracture? For example, a person who falls and hurts their wrist because they had a stroke or heart attack will have their fracture care delayed to allow care for the life threatening illness. A multiple trauma victim may have their orthopedic surgery delayed to address bleeding in the brain, chest or abdomen.

Physical exam follows the history of the injury. The injured area will be examined and a search will happen for potential associated injuries. These include damage to skin, arteries and nerves.

Pain control is a priority and many times, pain medication will be prescribed before the diagnosis is made. If the health care professional believes that an operation is potentially required, pain medication will be given through an intravenous (IV) line or by an injection into the muscle. This allows the stomach to remain empty for anesthesia.

A decision will be made whether X-rays are required, and which type of X-ray should be taken to make the diagnosis and better assess the injury. There are guidelines in place to help health care professionals decide if an X-ray is necessary. Some include the Ottawa ankle and knee X-ray rules. These rules were developed to minimize the number of X-rays taken, and decrease the radiation in which a patient is exposed.

The body is three dimensional, and plain film X-rays are only two dimensional. Therefore, two or three X-rays of the injured areas may be taken in different positions and planes to give a true picture of the injury. Sometimes the fracture will not be seen in one position, but is easily seen in another.

There are areas of the body where one bone fracture is associated with another fracture at a more distant part. For example, the bones of the forearm make a circle and it is difficult to break just one bone in that circle. Think of trying to break a pretzel in just one place, it is difficult to do. Therefore broken bones at the wrist may be associated with an elbow injury. Similarly, an ankle injury can be accompanied by a knee fracture. The health care professional may X-ray areas of the body that don't initially appear to be injured.

Occasionally, the broken bone isn't easily seen, but there may be other signs that a fracture exists. In elbow injuries, fluid seen in the joint on X-ray (sail sign) is an indicator of a subtle fracture. And in wrist injuries, fractures of the scaphoid or navicular bone may not show up on X-ray for one to two weeks, and diagnosis is made solely on physical examination with swelling and tenderness over the snuffbox at the base of the thumb.

In children, bones may have numerous growth plates that can cause confusion when reading an X-ray. Sometimes, the health care professional will X-ray the opposite arm, leg or joint for comparison to determine what normal is for that child before deciding whether a fracture exists.

Medically Reviewed by a Doctor on 4/9/2013

Patient Comments

Viewers share their comments

Fracture - Describe Your Experience Question: Please describe what type of fracture you experienced.
Fracture - Causes Question: What caused your fracture?
Fracture - Treatment Question: Besides surgery, what types of treatment did you have for your bone fracture?
Bone Fracture - Signs and Symptoms Question: How did you know you had more than a sprain or strain? What were your signs and symptoms of a broken bone?
Bone Fracture - Surgery Question: Did you have surgery to fix your broken bone(s)? Which bone(s) did you fracture?