How to tell if a bone is fractured or bruised

• Signs of a bone fracture
• Common broken bones in children
• Different types of fractures
• What is a bone bruise?
• How to treat a broken or bruised bone
• Healing process of a broken bone

Signs of a bone fracture

Broken bones are most common in the upper and lower extremities (limbs). The upper extremities include the arms, elbows, wrists and fingers and the lower extremities include the legs, knees, ankles and feet. Tendon and ligament injuries (sprains and strains) can occur in these areas as well, but do not occur as frequently in children.

If your child has an extremity injury, there are a few ways to determine if they need to be seen immediately or if it can wait until later. Some symptoms may seem obvious; others may not. The general signs of a fracture are:

• Pain
• Bruising
• Swelling with tenderness over the area involved

If the child or adult heard a snap or grinding sound when the injury occurred, it is more likely to be a fracture, but not necessarily.

Regardless of when they need to be seen, our same day orthopaedic clinic is open Monday through Friday from 8 a.m. to 4 p.m.  and can be reached by calling (804) 828-2467.

Common broken bones in children

• Ankles: This typically occurs from a twist or fall from an activity like skateboarding, running, riding on a scooter or rollerblading.
• Elbows: A common injury making up about 10% of fractures in kids, elbow fractures happen when a bone breaks at or near the elbow joint and can happen in one or more of the three bones that make up the elbow.
• Forearms: Forearm fractures are the most common type of fractures in children. A fracture can occur anywhere on the two bones that make up the forearm (called the radius and the ulna)
• Femur fracture: Your femur bone is the largest bone in the body and connects the pelvis together to form the hip. Most commonly femur fractures occur close to the knee through the growth plate since it is weaker than the bone.
• Tibial shaft fracture: The tibial shaft area refers the shin bone and the smaller fibula bone that make up the major bones in the lower leg. Most commonly, the tibia breaks in the middle of the bone (which is called the tibial shaft), but the shin bone can face other types of fractures depending on the force of the injury. Fractures also occur frequently in kids in the growth plates at the end of the tibia that is part of the ankle.

What are the different types of fractures?

• Open vs closed fractures: Bone fractures are classified as either open or closed. A closed fracture happens when the bone is broken but hasn’t come out of the skin. An open fracture, also known as a compound fracture, is a relatively rare occurrence in children and happens when the bone breaks through the skin.

• Non-displaced fracture: Occurs where there is a crack in the bone, but the bone hasn’t shifted out of place. Stress fractures (that occur when tiny cracks form in the bone) or buckle fractures (when one side of the bone buckles upon itself) are two common non-displaced fractures. They can typically be treated with a brace, splint or cast.
  • Displaced fractures: This happens when a bone is broken, and it moves out of position. Displaced fractures can be broken into a few types:
  • Greenstick: When one side of the bone is broken, causing the other to bend like a broken tree branch.
  • Rotated: When the bone spun when it broke
  • Angulated:  When the ends of the broken bone are angled to each other
  • Translated:  When the bones have shifted out of alignment

• Growth plate fracture: Growth plates refer to the softer pieces of developing cartilage tissue, which form the length and shape of the bone. Left untreated, a growth plate fracture can lead to issues with growth and bone development. Since your child is still growing, the growth plates can be very prone to injury so injury prevention during sports and playground activities is especially important.

What is a bone bruise?

Bone bruises are less severe than bone fractures. This happens when the bone gets several small cracks with blood and fluid building among the cracks right under the skin. The most common areas for bone bruising occur are the knee and ankle.

If your child is experiencing severe pain, swollen or tender area near the injury, swollen or stiff joints near the injury or changes in skin color over the injury, it might be bruised.

We recommend that you seek medical attention so we can check the injured area and determine whether the bone is broken or bruised.

Treating a broken or bruised bone: When to seek care and how to help

Our walk-in orthaepedic clinic can see your child if you suspect your child has a bruised or broken bone.

A child should be seen ASAP if:

• The extremity has a deformity (may look like a bump or change in shape around the bone).
• There is a break in the skin and bone is showing.
• The child cannot bear weight on or use the extremity 15 minutes after the injury occurred
• The child’s pain is not being controlled and the child is crying with rest, elevation, ice and over-the-counter pain medication.

If ANY of these things are true seek medical attention immediately and do not allow the child to eat in case surgery or a procedure to align the fracture is needed. If there is severe bleeding, a break in the skin or a question of a spinal injury, call for emergency care.

If the extremity appears deformed, clothing should be carefully removed or cut from the injured limb and the limb should be supported with a makeshift splint. A makeshift splint can be made with some soft padding around the injury and something firm extending beyond the joints above and below the injury. The American Academy of Pediatrics recommends wrapping a small board, cardboard or folded up newspapers with an elastic bandage or tape to make a temporary splint. 

If all of the above things are negative and the extremity is not very swollen, then the child can potentially wait to see a physician in an outpatient clinic to have an exam and get x-rays if needed. To reduce swelling, you can apply cold compresses or ice wrapped in cloth, a towel or other material, but do not apply ice directly to the skin as this could cause frostbite (freezing of the skin and underlying tissues).

Most broken bones will be recognized immediately or within a day if a child is still not able to use the extremity as usual. If after a day this is the case, the child should be seen in an outpatient clinic, either with the primary care doctor or an orthopaedic surgeon. Although many children are not able to tell us exactly where this type of injury is, they usually will protect that extremity or cry when it is touched, which is another sign that a child may need medical care.

Sometimes x-rays will not show a fracture if it is through the growth plate and the child will still be treated for a fracture if there is enough suspicion. Growth plates are cartilage and do not show up on x-ray. Therefore a fracture through the growth plate that has not moved or shifted will not show on the x-ray. These are minor fractures, but still may need to be immobilized for symptoms and to protect the child from doing more harm.

To learn more about ankle, elbow, femur, forearm or growth plate injuries and how each are treated, see the “I Broke My…” section of the Pediatric Orthopaedic Society of North America website.

How long does it take to heal a broken bone?

Depending on the type of bone and the severity of the break, it can take about six weeks or more until your child can return to normal activity. For example, bigger bones will take longer to heal than smaller bones.

Our orthaepedic specialists will walk you through the what the healing process will be like, how long it will take for the broken bone to heal and answer any other questions you have.

A broken bone can be scary, but with proper care and treatment, they will heal and be okay.

Disclosure:  This article is solely dealing with extremity injuries and not multiple traumas including possible abdominal or head injuries. If any of those are suspected, seek medical attention immediately. Do not move the child if there is suspected neck or spine injury.

Originally published in April 2016
Updated July 2020