Break or Fracture?


A young girl getting a cast put on

Parents and sports coaches often ask if an injury is a break or a fracture? Our expert on this topic, Candice O. McDaniel, M.D., a Pediatric Orthopaedic Surgeon, is going to help answer questions on the types of fractures and the care needed to help your child heal.

What is a fracture?

A fracture is any loss of continuity of bone. Anytime the bone loses integrity—whether it is a hairline crack barely recognizable on an x-ray or the shattering of bone into a dozen pieces—it’s considered a fracture. A broken bone is a fractured bone. Most fractures affect the upper part of the body; the wrist, the forearm, and above the elbow. Why? When kids fall, it is a natural reflex for them to throw their hands out in an attempt to stop the fall and catch themselves.

How do I know if it is broken?

The classic signs of a fracture are pain, swelling, and abnormal bump or change in shape of the bone. Some telltale signs that a bone is broken are:

Dr. McDaniel looking at an X-Ray

  • You or your child heard a snap or a grinding noise during the injury.
  • There is swelling, bruising, or tenderness around the injured part.
  • It is painful for your child to move it, touch it, or press on it; if the leg is injured, it is painful to bear weight on it.
  • The injured part looks deformed. In severe breaks, the broken bone might poke through the skin.

What do I do?

  • Remove clothing from the injured area.
  • Apply an ice pack wrapped in cloth.
  • Keep the injured limb in the position you find it.
  • Place a simple splint, if you have one, on the broken area. A splint holds the bone still and protects it until the child is seen by the doctor. To make a temporary splint, you can use a small board, cardboard, or folded up newspapers and wrap it with an elastic bandage or tape.
  • If urgent, go to the emergency room.
  • If non-urgent, call your doctor to schedule an appointment for medical care.

Is it important to see a doctor the same day as the injury?

If you have concern for a fracture/broken bone in your child, your physician can evaluate your child and determine the best course of action.  Imaging studies such as radiographs, MRI, and/or CT are often necessary to fully diagnose the injury.  Sometimes the injury is such that you can appreciate a deformity in the extremity, or an open fracture.  These children are usually seen in the emergency room where an appropriate intervention can be performed by the physician sin the emergency room or a specialist.

Dr. McDaniel with a young patient

Do a break and a sprain look the same?

A broken bone and a sprain can look very similar.  Due to the nature of the immature bone and growth plates being weaker than the adjacent soft tissues/ligaments, more often than not in children there is a fracture present.

What’s the difference between a complex and simple fracture?

Open fractures are often referred to as compound fractures.  This occurs when the bone at the fracture site goes through the skin, or there is a very deep wound in the skin and muscle that exposes the bone to the outside environment.  Closed fractures can be referred to as simple fractures, but are best described as being displaced or nondisplaced, because the fact that they are closed does not necessarily mean that they are simple.  Greenstick fractures are incomplete fractures, and really only found in children due to the greater ability of their bones to bend prior to breaking.

What are most common causes of fractures that you see in clinic?

  • Hover boards
  • Trampoline
  • Monkey bars
  • Sports
  • Bike/scooter

How soon after break should child be casted?

Often a splint or wrist guard is adequate to treat the fracture. However, in other instances cast can offer excellent pain relief and fracture stabilization, so if we can get the child into a cast no later than 7-10 days, that is ideal.

For more information, please visit our Pediatric Fracture Follow-Up page.