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Fractura
A normal X-ray does not rule out a fracture — and breaking a bone in a fall from standing calls for an osteoporosis check.
Also known as: fracture · broken bone · greenstick fracture · stress fracture · open fracture · scaphoid fracture
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
With a fracture, doctors distinguish certain from uncertain signs. Certain signs are a visible deformity, abnormal movement, grating felt or heard, and bone ends visible in an open fracture. Uncertain signs — possible but not proof — are pain, swelling, bruising, guarding and being unable to bear weight. That is exactly why the X-ray decides in the end, not the feeling. In children much is different: soft bone bends rather than snapping, which is the greenstick fracture, and breaks through the growth plate are easy to miss on the image yet can affect later growth. Children’s fractures are therefore not small adult fractures and belong in experienced hands. Healing ranges from a few weeks in small bones such as a finger to several months in large ones such as the thigh or pelvis; full load-bearing usually returns later than the cast comes off. Important to know: a normal X-ray does not reliably rule out a fracture. The scaphoid at the wrist and stress fractures are the classic latecomers, visible only after days or weeks — if pain persists, get it rechecked. And anyone who breaks a bone after minor force, such as a fall from standing height, should be assessed for osteoporosis. That is the most frequently missed opportunity after a fracture.
Stop movement, splint as found, cool, elevate, do not straighten anything, stay fasted before possible anaesthesia.
Open fracture, clear deformity, a cold or numb limb, suspected spine, pelvis or thigh bone.
Scaphoid and stress fractures often show up only later. If pain persists, a recheck or another imaging method is needed.
The growth plate decides follow-up and treatment. Much straightens out with growth in children — but not everything, not alone.
The choice depends on the bone, displacement, age and daily life. A cast is not second-class treatment.
Pain that grows instead of easing, numbness, tingling or a tight cast mean: go back the same day, do not wait.
Early permitted movement of free joints, physiotherapy, enough protein, calcium and vitamin D, stopping smoking — smoking clearly slows bone healing.
A fall from standing, wrist, vertebra or hip: this is the moment for a bone density scan — see osteoporosis.
A simple fracture needs six to twelve weeks to knit; faster in a child, slower with age. Able to bear weight does not mean healed: bone remodelling carries on for months afterwards, and during that time the spot is not yet as strong as before.
No drug makes a bone heal faster. What the bone needs is rest at the fracture site and load around it — which is why mobilisation today starts as early as possible. Anti-inflammatory painkillers are suspected of delaying healing; they are usual for the first days, but over weeks paracetamol is preferred. Calcium and vitamin D work only if they are missing. A fracture needs six to twelve weeks before it bears weight and up to a year to be fully rebuilt.
Visible deformity, abnormal movement, grating or visible bone: the fracture is established.
Pain, swelling, bruising and guarding fit a fracture but also occur with a bruise or sprain.
Not managing a few steps or losing grip after an accident points to more than a bruise.
Small children rarely complain, they simply avoid using it. Greenstick and growth plate make little noise and matter a lot.
No accident, but load-related pain after more training — shin, midfoot and femoral neck are typical.
Pain worse than expected, numbness or tingling, a tight cast, cold pale toes or fingers: back to emergency at once.
Important for the healing and for the question of why the break happened at all. A break after a fall from standing height counts as a warning sign.
The blood value usually stays normal, because the body holds it up from the bone. It is only abnormal with a disorder of its own — and that is treatable.
Together with calcium and vitamin D it clarifies whether the parathyroid gland is drawing substance from the bone. This combination is often only measured after the second break.
Rises in the weeks after a break as a sign of bone being built. So a rise is nothing bad here.
Without vitamin D only a fraction of the calcium from food is taken up. It is the value that is most often too low with bone and joint complaints.
The building material itself. Better from food than from a tin: hard cheese, yoghurt, calcium-rich mineral water, almonds, broccoli and fortified plant drinks.
Activates the proteins that build calcium into bone. Green leafy vegetables and fermented foods cover it — under coumarin blood thinning the amount stays steady rather than swinging.
Bone is a third protein scaffold, and the muscles that hold it need protein too. In older people too little protein is more common than too little calcium.
Needed for building calcium in and for vitamin D to work. A lack slows both — even when calcium and vitamin D are supplied in sufficient amounts.
Without vitamin D the calcium is not built in. 20–50 µg (800–2000 IU) a day over the healing time is the usual frame; with a proven deficiency the stores are filled first.
1000 mg a day is the target — from food and supplement together, not on top. Above 500 mg at once the absorbed share falls, hence two doses.
A quarter of bone is protein. With hip fractures an added 20 g a day over 4 weeks showed fewer complications — in older people protein shortage is the more common bottleneck here than calcium.
Activates the protein that builds calcium into bone. 100–200 µg MK-7 a day is the usual frame — on warfarin-type blood thinners it is the one supplement not to add without discussion.
Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.
Persistently raised, this hormone breaks bone down — given in pulses it builds it up. The same substance, opposite effect, purely through the timing. The bone-building medicines rest on that.
Without this active form barely any calcium is taken up, and bone gets no building material. In older people with a hip fracture a deficiency is the rule rather than the exception.
In the first years after menopause bone is lost fastest — up to three per cent a year. A fracture from a low fall after fifty is therefore a reason to measure bone density, not only to treat the break.
A fracture heals in 6–12 weeks. In that time 1.2–1.5 g protein per kg a day, 1000 mg calcium and a balanced vitamin D level is the studied frame — too little protein measurably delays healing.
Both disturb new bone formation. In smokers healing takes several weeks longer on average and non-unions occur more often.
A deficiency measurably delays healing. Measured and replaced by finding — with a balanced level more brings nothing.
After immobilisation muscle loss is often the bigger problem than the fracture. Rebuilding starts as soon as the fracture allows — not only once it is fully healed.