A fracture is a break in a bone. It can be a small crack, a partial break or a complete separation of the bone into two or more pieces. Fractures are common after falls, sports injuries, road accidents, direct trauma and sudden twisting movements. They can also happen when bones are weak due to osteoporosis, cancer or long-term disease.
Bones are strong, but they can break when force is greater than the bone can tolerate. A fracture may be open, where the broken bone or wound breaks through the skin, or closed, where the skin remains intact. It may also be complete, meaning the bone breaks into separate pieces, or incomplete, meaning only part of the bone is broken.
Fractures need proper assessment because bone injury can also damage blood vessels, nerves, muscles and skin. Symptoms often include pain, swelling, bruising, deformity, reduced movement and tenderness. Some fractures are easy to see, while others need imaging.
Treatment focuses on restoring alignment, keeping the bone stable and preventing complications. Common treatments include reduction, immobilization, fixation and sometimes traction. Nursing care includes pain control, neurovascular checks, sterile dressing for open fractures, shock monitoring and patient education.
What Is a Fracture?
A fracture means the normal continuity of a bone is broken. The break can be small or severe. It may involve one bone, several bones, a joint surface or nearby soft tissues.
AAOS explains that fractures can be open, closed, transverse, oblique, comminuted and other patterns depending on the break and injury mechanism.
A fracture can affect:
- Bone structure
- Joint movement
- Muscle function
- Nerve function
- Blood flow
- Skin integrity
- Daily mobility
Fractures are not only “bone problems.” They are full limb injuries and need careful assessment.
Open vs Closed Fractures
Fractures are often grouped by whether the skin is broken.
| Type | Meaning | Main Concern |
|---|---|---|
| Open fracture | Broken bone communicates with an outside wound or punctures through skin | High infection risk |
| Closed fracture | Bone is broken, but skin remains intact | Swelling, bleeding, nerve or vessel injury |
Open Fracture
An open fracture, also called a compound fracture, happens when a wound exposes the fracture site to the outside environment. The bone may be visible, but it does not always have to be visible for the fracture to be open.
Open fractures are more serious because bacteria can enter the wound. Merck Manual notes that infection risk is highest with open or surgically treated fractures, and acute infection can lead to osteomyelitis.
Closed Fracture
A closed fracture means the bone is broken but the skin is intact. It is usually less exposed to infection than an open fracture, but it can still cause serious internal damage.
Closed fractures can still lead to:
- Bleeding inside tissues
- Swelling
- Nerve injury
- Compartment syndrome
- Poor alignment
- Delayed healing
Complete vs Incomplete Fractures
Fractures are also classified by how much of the bone is broken.
| Type | Meaning | Common Example |
| Complete fracture | Bone breaks completely into two or more pieces | Transverse fracture |
| Incomplete fracture | Bone is partially broken but not separated fully | Greenstick fracture |
Complete Fracture
A complete fracture goes through the full width of the bone. The bone may separate into two or more fragments.
Complete fractures often need reduction if the pieces are displaced.
Incomplete Fracture
An incomplete fracture is a partial break. Part of the bone remains connected.
This pattern is common in children because their bones are more flexible than adult bones.
Main Types of Fractures
Fracture patterns help clinicians understand the injury mechanism and choose treatment.
| Fracture Type | Description | Common Cause |
| Greenstick | One side bends and the other side breaks | Childhood falls |
| Comminuted | Bone breaks into multiple fragments | High-energy trauma |
| Spiral | Break twists around the bone shaft | Twisting injury |
| Transverse | Break runs straight across the bone | Direct force |
| Impacted | Bone fragments drive into each other | Falls or compression |
| Oblique | Diagonal break across the bone shaft | Angled force |
Greenstick Fracture
A greenstick fracture is an incomplete fracture where one side of the bone bends and the other side breaks.
It is more common in children because growing bones are softer and more flexible.
Comminuted Fracture
A comminuted fracture means the bone is broken into several pieces. It often happens after high-energy trauma, such as a car accident or major fall.
Comminuted fractures may need surgery because small fragments can be hard to align and stabilize.
Spiral Fracture
A spiral fracture twists around the bone shaft. It usually happens when a limb rotates while the foot or hand stays fixed.
Sports injuries and twisting falls can cause spiral fractures.
Transverse Fracture
A transverse fracture goes straight across the bone shaft. It often occurs from a direct blow or bending force.
AAOS describes transverse fractures as breaks with a horizontal fracture line.
Impacted Fracture
An impacted fracture occurs when two broken bone ends are driven into each other. This can happen after a fall from height or compression-type injury.
It is common in some wrist, hip and shoulder injuries.
Oblique Fracture
An oblique fracture has a diagonal line across the bone shaft. It may happen when force strikes the bone at an angle.
AAOS describes oblique fractures as angled fracture patterns.
Common Causes of Fractures
Fractures can happen in healthy bones after major force or in weak bones after minor force.
Trauma
Trauma is a major cause.
Common examples include:
- Falls
- Car accidents
- Bike accidents
- Sports collisions
- Direct blows
- Crush injuries
- Workplace injuries
Weakened Bones
Weak bones break more easily.
Common causes include:
- Osteoporosis
- Bone cancer
- Long-term steroid use
- Poor nutrition
- Vitamin D deficiency
- Metabolic bone disease
- Advanced age
A fracture that happens after minimal trauma may suggest poor bone strength.
Sudden Twisting Motions
Twisting injuries often affect long bones and joints.
Examples include:
- Football injury
- Skiing injury
- Basketball pivot injury
- Fall with planted foot
- Arm caught during a fall
Twisting force can cause spiral or oblique fracture patterns.
Risk Factors for Fractures
Risk factors include:
- Older age
- Osteoporosis
- Poor balance
- Previous fracture
- Low calcium or vitamin D
- High-impact sports
- Heavy physical work
- Alcohol misuse
- Smoking
- Certain medicines
- Unsafe home environment
- Vision problems
- Neurological disease
Fall prevention is important in older adults because hip, wrist and spine fractures can reduce independence.
Symptoms of a Fracture
Fracture symptoms depend on location, severity and soft tissue injury.
Common symptoms include:
- Pain over the site
- Swelling
- Bruising
- Reduced movement
- Visible deformity
- Tenderness
- Crepitus with movement
- Sensory impairment
- Weakness
- Inability to bear weight
- Open wound in open fracture
Mayo Clinic first aid guidance lists fracture warning signs such as swelling, bruising, pain, deformity and inability to move or use the affected part.
Crepitus
Crepitus is a grating or crackling feeling caused by broken bone ends moving against each other.
Do not try to reproduce crepitus. Unnecessary movement can worsen pain and tissue damage.
Sensory Impairment
Sensory impairment means numbness, tingling or loss of feeling. It can happen when swelling or bone fragments irritate nerves.
Report sensory changes quickly because they may suggest neurovascular compromise.
Diagnosis of Fractures
Diagnosis starts with history, physical examination and imaging.
History
A clinician asks:
- How did the injury happen?
- Was there a fall, crash or twist?
- Where is the pain?
- Can the limb move?
- Can the person bear weight?
- Is there numbness or tingling?
- Is there an open wound?
- Was there a previous fracture?
- Does the person have osteoporosis or cancer?
Physical Examination
The exam may include:
- Inspection for deformity
- Swelling assessment
- Skin and wound check
- Pain assessment
- Distal pulse check
- Capillary refill
- Sensation
- Movement
- Joint involvement
- Signs of shock
Assessment should be gentle. Avoid unnecessary movement of the injured area.
Imaging
Common imaging tests include:
| Test | Purpose |
| X-ray | First-line test for most fractures |
| CT scan | Shows complex bone detail |
| MRI | Shows occult fractures and soft tissue injury |
| Bone scan | May help detect stress fractures |
| Ultrasound | Sometimes used in selected settings |
X-rays are commonly used to confirm fracture location, pattern and alignment.
Treatment of Fractures
Fracture treatment has three main goals:
- Restore bone alignment.
- Keep the bone stable.
- Support healing and function.
Treatment depends on:
- Fracture type
- Bone involved
- Displacement
- Open or closed injury
- Joint involvement
- Nerve or vessel injury
- Patient age
- Overall health
- Activity needs
Reduction
Reduction means restoring bone alignment.
| Type | Meaning |
| Closed reduction | Bone is realigned without surgery by external manipulation |
| Open reduction | Bone is surgically realigned through an incision |
Closed reduction may be used when the bone can be aligned without an incision. Open reduction is used when the fracture is unstable, open, complex or cannot be aligned externally.
Immobilization
Immobilization means limiting movement so the bone can heal. It maintains reduction and reduces pain.
Immobilization may include:
- Splint
- Cast
- Brace
- Sling
- Boot
- Traction device
NCBI explains that immobilization stabilizes suspected fractures or dislocations, limits motion at the injury site and reduces further skeletal, neurologic or soft-tissue injury during movement and transport.
Fixation
Fixation stabilizes fractured bone using hardware or frames.
| Type | Description |
| External fixation | Pins or wires attach bone to an outside frame |
| Internal fixation | Plates, screws, rods or pins are placed inside the body |
External fixation is often used in open fractures, severe swelling or complex trauma. NCBI notes that external fixation aims to maintain fracture length, alignment and rotation.
Traction
Traction uses a pulling force to align or stabilize a bone. It may use weights, pulleys or special splints.
Traction can help:
- Reduce muscle spasm
- Improve alignment
- Decrease pain
- Support displaced fractures
NCBI notes that traction splints can help align femur fractures, improve arterial blood flow and reduce pain and spasm in emergency care.
First Aid for Suspected Fracture
Fractures need prompt medical care. First aid should prevent further injury.
Mayo Clinic advises stopping bleeding with pressure, keeping the injured area from moving and not trying to realign the bone or push a protruding bone back in.
First Aid Steps
- Call emergency help for severe injury.
- Stop bleeding with clean pressure.
- Cover open wounds with a sterile dressing.
- Immobilize the area if trained.
- Apply cold packs over cloth.
- Keep the person still and calm.
- Watch for shock.
- Do not give food or drink if surgery may be needed.
Nursing Interventions for Fractures
Nursing care focuses on safety, pain control, circulation and complication prevention.
Follow PRICE
PRICE is a common injury care memory tool.
| Letter | Meaning |
| P | Protect |
| R | Rest |
| I | Ice |
| C | Compress |
| E | Elevate |
Use compression and elevation only when appropriate. Do not apply tight compression if circulation is compromised.
Apply Sterile Dressing to Open Fractures
Open fractures need sterile wound coverage.
Nursing priorities include:
- Cover wound with sterile dressing
- Avoid pushing bone back inside
- Monitor bleeding
- Prepare for antibiotics as ordered
- Prepare for tetanus prophylaxis if ordered
- Monitor for infection signs
Monitor Vital Signs and Shock
Fractures can cause internal bleeding, especially pelvic and femur fractures.
Monitor:
- Blood pressure
- Heart rate
- Respiratory rate
- Skin color
- Mental status
- Urine output
- Pain level
- Signs of bleeding
Signs of shock include pale skin, cold clammy skin, fast pulse, low blood pressure, restlessness and confusion.
Pain Management
Pain control is essential.
Nursing actions include:
- Assess pain score
- Immobilize the limb
- Give analgesics as ordered
- Apply ice if appropriate
- Reduce unnecessary movement
- Support limb positioning
- Reassess after interventions
Increasing pain despite treatment may signal compartment syndrome.
Keep NPO if Surgery Is Possible
NPO means nothing by mouth.
If surgery may be needed, keep the patient NPO as ordered to reduce aspiration risk during anesthesia.
Log Roll if Spinal Cord Injury Is Suspected
If spinal injury is possible, avoid twisting the spine. Use log rolling with trained help.
This keeps the head, neck and spine aligned during movement.
Neurovascular Assessment
Fractures can injure blood vessels and nerves. Frequent neurovascular checks are critical.
Assess the affected limb for:
- Pain
- Pulse
- Pallor
- Paresthesia
- Paralysis
- Poikilothermia
- Capillary refill
- Swelling
- Movement
- Sensation
Compare both sides when possible.
Complications of Fractures
Fractures can cause early and delayed complications.
| Complication | Main Concern |
| Fat embolism | Fat enters circulation and blocks vessels |
| Osteomyelitis | Bone infection |
| Compartment syndrome | Pressure cuts off circulation |
| Malunion | Bone heals in wrong position |
| Nonunion | Bone does not heal |
| Nerve injury | Weakness or numbness |
| Vascular injury | Poor blood flow |
| DVT | Blood clot from immobility |
Fat Embolism
Fat embolism can occur when fat from bone marrow enters the bloodstream. It is more common with long bone fractures, especially femur fractures.
MSD Manual notes that fractures of long bones, most commonly femoral fractures, may release fat and marrow contents that embolize to the lungs.
Signs may include:
- Mental status changes
- Tachypnea
- Shortness of breath
- Low oxygen levels
- Petechiae
- Fever
- Confusion
Fat embolism is a serious complication and needs urgent medical attention.
Osteomyelitis
Osteomyelitis is an infection of the bone. It can occur after open fractures, surgery or bloodstream infection.
Cleveland Clinic describes osteomyelitis as a bone infection that can cause permanent bone damage if not treated early. Warning signs include warmth, pus or discharge and fever.
Symptoms may include:
- Bone pain
- Fever
- Swelling
- Redness
- Drainage
- Warmth
- Delayed healing
Open fractures need strict sterile care because infection prevention is a key priority.
Compartment Syndrome
Compartment syndrome occurs when swelling or bleeding raises pressure inside a muscle compartment. This pressure can reduce blood flow and damage nerves.
Symptoms are remembered by the 6 P’s:
| Sign | Meaning |
| Pain | Severe pain, often out of proportion |
| Pallor | Pale skin |
| Pulselessness | No distal pulse, usually late |
| Paresthesia | Tingling or numbness |
| Poikilothermia | Cool limb |
| Paralysis | Inability to move, late sign |
MSD Manual notes that compartment syndrome should be considered when pain is out of proportion and worsens with passive stretching.
Patient Education After a Fracture
Patient education improves healing and prevents complications.
Teach patients to:
- Keep follow-up appointments
- Do not remove cast or splint without advice
- Keep cast dry if instructed
- Avoid putting objects inside the cast
- Report numbness or tingling
- Report severe swelling
- Report worsening pain
- Report foul odor or drainage
- Take medicines as prescribed
- Eat protein-rich meals
- Maintain calcium and vitamin D intake
- Stop smoking if possible
- Do prescribed exercises
Cast Care Teaching
Patients with casts should monitor circulation.
Report:
- Fingers or toes turning blue
- Severe swelling
- Numbness
- Tingling
- Burning pain
- Increasing tightness
- Wet or broken cast
- Bad smell
- Drainage
A tight cast can reduce circulation and increase compartment pressure.
Fracture Healing
Bone healing happens in stages.
| Stage | What Happens |
| Inflammation | Bleeding and clot form around fracture |
| Soft callus | Early repair tissue bridges the fracture |
| Hard callus | New bone strengthens the area |
| Remodeling | Bone reshapes over time |
Healing time varies. Simple fractures may heal in weeks, while complex fractures can take months. Healing depends on age, nutrition, blood supply, fracture type, smoking status and medical conditions.
Quick Review Table
| Topic | Key Point |
| Definition | Break in bone continuity |
| Open fracture | Skin is broken, infection risk is higher |
| Closed fracture | Skin remains intact |
| Complete fracture | Bone separates completely |
| Incomplete fracture | Bone is partly broken |
| Common symptoms | Pain, swelling, bruising, deformity |
| Main treatment goals | Align, stabilize and heal |
| Reduction | Restores bone alignment |
| Immobilization | Maintains alignment during healing |
| Fixation | Stabilizes bone with hardware or frame |
| Major complications | Fat embolism, osteomyelitis, compartment syndrome |
FAQs
1. What is a fracture?
A fracture is a break in a bone. It may be a small crack, partial break or complete break into separate pieces. Fractures usually happen after trauma, falls or twisting injuries. They can also occur in weak bones due to osteoporosis or cancer.
2. What is the difference between an open and closed fracture?
An open fracture has a wound where the fracture site communicates with the outside environment. The broken bone may or may not be visible. A closed fracture means the bone is broken but the skin remains intact. Open fractures have a higher risk of infection and need urgent sterile care.
3. What is the difference between complete and incomplete fracture?
A complete fracture breaks through the entire bone and separates it into two or more pieces. An incomplete fracture breaks only part of the bone. Incomplete fractures are common in children because their bones are more flexible. Greenstick fracture is a common incomplete fracture.
4. What are the common types of fractures?
Common types include greenstick, comminuted, spiral, transverse, impacted and oblique fractures. A greenstick fracture bends on one side and breaks on the other. A comminuted fracture breaks into multiple fragments. A spiral fracture twists around the bone shaft.
5. What are the main symptoms of a fracture?
Common symptoms include pain, swelling, bruising, reduced movement and tenderness. Some patients may have visible deformity or crepitus with movement. Numbness, tingling or weakness may suggest nerve involvement. Open wounds near a fracture need urgent care.
6. How are fractures diagnosed?
Fractures are diagnosed through history, physical examination and imaging. X-ray is the most common first test. CT scan may be used for complex fractures, while MRI can detect occult fractures and soft tissue injury. The clinician also checks blood flow, sensation and movement.
7. What is reduction in fracture treatment?
Reduction means restoring the broken bone to proper alignment. Closed reduction is done without surgery by external manipulation. Open reduction is done surgically through an incision. Proper alignment helps the bone heal in the correct position.
8. What is immobilization in fracture care?
Immobilization means keeping the injured bone from moving during healing. It may involve a cast, splint, brace, sling or boot. Immobilization reduces pain and prevents further tissue injury. It also helps maintain bone alignment after reduction.
9. What are serious complications of fractures?
Serious complications include fat embolism, osteomyelitis and compartment syndrome. Fat embolism is more common with long bone fractures. Osteomyelitis is a bone infection, especially a risk in open fractures. Compartment syndrome can cut off circulation and cause nerve damage.
10. What nursing care is important for fractures?
Important nursing care includes pain management, immobilization support and frequent neurovascular checks. Nurses monitor pulse, color, temperature, capillary refill, sensation and movement. Open fractures need sterile dressing and infection prevention. Patients may also need shock monitoring, NPO status before surgery and safe movement support.
