Is it a Fracture or a Break?
Which one is it?
I get asked this question a lot.
Did my son fracture his foot or did he break it?
I get the impression that some people feel that a fracture is just a crack in the bone and that a break is when the bone is completely split through.
Or even vice versa. But what is the correct answer?
WARNING: GRAPHIC IMAGES TO FOLLOW.
There are many types of boney fractures and breaks.
Image of a likely open fractured thumb with lacerated skin.
Closed and open fractures
A closed fracture is when a broken bone remains contained under intact skin. An open fracture is when the bone protrudes through the skin.
An open fracture is a serious injury and should be treated as an emergency. There is high risk of infection due to exposure to the outside world and that infection can settle into the fracture and be hard to treat.
This type of injury needs to be seen in an emergency room quickly.
Nondisplaced and displaced fractures
A nondisplaced fracture appears as a line on the x-ray, indicating that the fracture is intact and has not moved. A displaced fracture is when the broken part of the bone has moved away from its original position.
In some instances, a displaced fracture requires surgical intervention to replace it back to the correct position for optimal healing. Other times, a displaced fracture can remain in the new location and the gap will fill in with bone to heal.
The first image is a very displaced apparent femur fracture that will require surgery to better align the bone and keep it in place for proper healing. The second image is that of a nondisplaced distal radius fracture.
A displaced femur fracture.
A nondisplaced distal radius fracture.
Growth plate fractures
A growth plate fracture, also known as a Salter Harris fracture, is a fracture that involves the growth plate of a bone.
These fractures only happen in children and those that have open growth plates.
These are sometimes missed because, based on the type of fracture it is, it may not show on the x-ray at all. If the fracture is only within the growth plate and doesn’t go through the bone itself, it will not show on x-ray. I will go into more detail about Salter Harris fractures in another post.
Open growth plates.
Comminuted fractures
Comminuted fractures occur when a fracture has multiple fragments and displace to some degree. Think about what happens if you drop an ice cube and it breaks into many pieces.
These can be difficult because often times the pieces are not large enough to fix with surgery and will need to fill the space between the fragments with bone, but the fragments must be close enough to each other to be able to build a boney bridge and then fill in.
This image is of a comminuted clavicle (collarbone) fracture. As you can see by the arrow pointing, the end of the clavicle is in many pieces and no longer attached to the larger piece on the left.
Comminuted fracture of the distal clavicle.
Spiral fractures
Spiral fractures are S shaped and typically caused by a twisting motion at one end of the bone and a fixation at the other.
Think about opening a can of refrigerated biscuits. The way that a cardboard wrapper opens is like a spiral fracture.
On this image, it is a little hard to tell, but there is a spiraling effect to that fracture, similar to a spiral slide at a playground.
A spiral fracture of the distal tibia.
Image of a spiral slide for comparison.
Occult fractures
No evidence of fracture on x-ray.
Occult fractures can be difficult to diagnose as they don’t typically show on an x-ray.
They typically have the same mechanism that would cause other types of fractures and respond like a fracture (pain, swelling, difficulty using or moving), but usually will require a CT scan or MRI to assess the injury.
As you can see, this x-ray appears normal. You don’t see any fracture lines or boney evidence of a fracture.
Stress fractures
Stress fractures are not fractures like you typically think of fractures. There is not one singular event that causes a bone to break, but it is a fracture that develops over time when the bone has not been able to adapt to the stress applied to it.
I have heard it likened to taking a paper clip and bending it back and forth. You can bend it back and forth 5-6 times and it will remain intact, but eventually it will get “hot” and will break if you keep moving it back and forth. Imagine a bone is the paper clip and with repeated stress, the bone begins to break down and if left untreated, will eventually cause the bone to break.
Both images below are 5th metatarsal Jones stress fractures. On the left, the image is nondisplaced and on the right, there is a large gap between the two fracture parts. Due to the inherit nature of this type of fracture, they almost always require surgery, especially in athletes. These type of fractures do not do well on their own due to a lack of blood flow to this part of the bone. I’ll save discussing different types of 5th metatarsals for a different post.
Image of a 5th metatarsal Jones stress fracture.
Image of advanced 5th metatarsal Jones fracture healing.
So which one is it?
A fracture or a break?
Well…
The answer is it is both.
A fractured bone is a broken bone and a broken bone is a fractured bone.
They are the same thing.
So the next time your neighbor asks if you broke your finger or fractured it, you can tell them you did both.
What questions do you have about fractures or breaks? Leave your question in the comments below.
What other types of sports injuries would you like to learn about? Tell me in the comments section or follow the link below.
Disclaimer: This post is for informational and educational purposes only, does not constitute medical advice, and does not establish any patient relationship with me. I’m not liable or responsible for any damages related to your use of this information. Information given is a generality of athletic injuries and treatments and is not meant to replace traditional medical advice. Please consult a physician for proper care.