Stubbed toes, bumped shins and twisted ankles. Banging your knee and landing on your wrist. These are some of the many trip-and-fall injuries threatening the 206 bones in your body. But how can you tell if your pain indicates a fracture, which is a true break in the bone, or something more minor, like a bruised muscle or sprained ligament? What physical signs should you take seriously? And how long can you wait to see a doctor?
Bone injuries vary so widely that it’s hard to come up with blanket recommendations for care. But once you learn to recognize the different types, you’ll know what to do about them.
How do you know it’s a fracture?
“The most important information that people have to keep in mind is that ‘fracture’ refers to a very broad gamut of injuries, from truly minor things — that if you never saw any healthcare you’d be fine — to life-threatening injuries and devastating fractures that require surgery,” says Dr. Paul Levin, an orthopedic surgeon and vice chairman of the department of orthopedics at Montefiore Medical Center in New York.
General symptoms of fractures include:
- Swelling or bruising
- Deformity, like an arm or leg looking visibly contorted
- Pain, especially in response to palpation, which means the pain gets worse when the area is moved or pressure is applied
- An inability to bear weight on the affected area, meaning you can’t stand on the injured foot, ankle or leg
- Loss of function in the injured area, such as being unable to move your wrist, elbow or arm
Some of these symptoms, such as pain and swelling, also occur with a sprain, which is when you stretch or tear a tendon or ligament.
The most common way to diagnose a fracture is by taking an X-ray of the injured area. Sometimes a suspected fracture won’t show up in an X-ray. This can happen with wrist fractures, hip fractures and stress fractures. In these cases, a doctor may perform additional imaging tests, such as CT or MRI scans.
Whether it’s a fracture or a sprain, first aid care should follow the RICE method:
- Rest and avoid using the affected area
- Apply ice
- Compress (i.e., tightly wrap) the injured area to stabilize it, reduce blood flow and limit swelling
- Elevate the limb
You can also take over-the-counter pain medication like acetaminophen (Tylenol) or ibuprofen (Advil) to manage the pain.
Bottom line: If you can’t bear weight on or move the injured area, or notice any visible deformity, you might have a fracture.
When should you see a doctor?
Some injuries require immediate medical attention, such as an open (or compound) fracture, where an open wound perforates the skin covering the broken bone. Fractures that affect the blood supply, where a limb turns blue or feels cold and numb, also need to be checked out as soon as possible. If you’re headed to the hospital with a serious injury, don’t eat or drink — you may need to be put under general anesthesia while your bone is realigned.
But for many other suspected bone injuries, it can be unclear if you can afford to wait until tomorrow. “This is an age-old question,” Levin says. “If you are in excruciating pain, or you can’t stand on your leg, you may have no choice but to go to the ER, where you are going to get the most immediate treatment. If you see deformity — that is, if an arm or leg looks abnormal, crooked or bent — that’s the sign of a more severe injury that should also be seen immediately. Really, you have to go by your level of pain, deformity and ability to bear weight on the injured area.
For minor injuries, it’s okay to let some time pass before seeking care. Even if the injury turns out to be a fracture, and even if treatment would involve surgery, Levin says waiting a few days won’t compromise your long-term care.
Children and adolescents, whose bones are still growing and are prone to unique injuries, need to see a doctor sooner.
Yet if pain and swelling persist after a few days, it’s time to get to a doctor, says Dr. Lisa Cannada, an orthopedic trauma surgeon and associate professor of traumatology at the The University of Florida College of Medicine – Jacksonville. “Don’t wait more than one to two days, because you don’t want to cause further damage. You can have a small crack, but if you continue your normal activity, it could progress to a larger fracture.”
Children and adolescents, whose bones are still growing and are prone to unique injuries, need to see a doctor sooner. “Sometimes in the younger kids, parents think they just have a sprain when it might be a fracture involving their growth plate, and that’s more serious,” Cannada says. Growth plates are the growing tissue at the end of young bones. A potential growth-plate injury should be treated before a bone begins to heal.
Bottom line: Most fractures require treatment at a hospital, but you might not need emergency care for minor fractures, which can often go a few days untreated. Either way, apply the RICE method.
Where in the body is a fracture most serious?
Breaking a toe is obviously less dangerous than breaking your spine. Similarly, people have to be more cautious about fractures that threaten function, such as those surrounding joints, Cannada says.
Neck and back injuries happen all the time, especially from playing sports or being rear-ended in a car accident. While they’re common and often benign, they still need to be evaluated right away, Levin says. “For a small percentage of people, the pain could reflect a spine injury, which, if not treated, could lead to spinal cord and neurologic injuries.”
If you suspect you have a severe back or neck injury that could threaten the spinal cord, call 911 and let paramedics move you safely.
Bottom line: Use extra caution if you injure your neck or back.
Is it possible to tell a sprain from a fracture?
Sprains, in most cases, just need time to heal naturally — there’s not much your doctor can do to expedite recovery. But how do you know if you’re dealing with a sprain rather than a fracture? “It’s really hard for people to tell without seeing an X-ray,” Cannada says. To complicate things further, fractures and sprains can occur together.
An ankle injury is an example of a common accident that’s tricky to self-diagnose. In general, if you have pain in the soft tissue around the ankle but not directly over the bone when you touch it, you might have a sprain. Pain related to a sprain usually gets worse with motion. You should still be able to put body weight on your ankle.
If your ankle bone hurts to the touch, you most likely have a break. Another indication of a break is an inability to stand and walk on your ankle. Any visible change in how the ankle bone looks is a sure sign of a break.
If you’ve hurt your ankle but you’re not sure how serious it is, you can monitor it for a couple of days and use the RICE method. If pain and difficulty bearing weight continue after a few days, or if you notice black and blue spots around the ankle, it’s time to see a doctor.
Bottom line: If you’re not sure whether you have a sprain or a fracture, and your pain is manageable, you can make an appointment with your regular doctor.
Myths and misconceptions
Fractures aren’t a particularly well-understood injury. “I’ve been doing this job for more than 30 years and I’ve heard all sorts of misinformation,” Levin says. Here are some facts to set the record straight:
- Some people think fractures and breaks are different. “They are the same thing,” says Levin. “A fracture or break is a disruption in normal bone structure.”
- When people hear “fracture,” they think it’s a devastating injury. “A fracture can be anywhere from very minor to something truly devastating that requires surgery to restore function,” Levin says.
- Pain doesn’t tell the whole story. Most people think fractures cause more pain than other types of injury, but that’s not always the case. Sprains and soft tissue damage can be excruciating. So although pain is a reliable sign you have some sort of injury, it doesn’t necessarily mean you have a fracture. Moreover, everyone has a different tolerance for pain, Cannada says.
- You may have heard that fractures make a sound, but most of the time they don’t. In fact, people are more likely to hear a pop when they tear a ligament, Levin says. Regardless, pops, cracks and other noises rarely tell you much about the nature of the injury.
- Orthopedists frequently use the word “reduction” when describing treatment. That means lining up the fractured bones to prevent them from rubbing on each other, which leaves them in a good position to heal.