Sometimes an X-ray will not show a fracture. This is especially common with some wrist fractures, hip fractures (especially in older people), and stress fractures. In these situations, your doctor may perform other tests, such as a computed tomography (CT) scan. Occasionally, even after the fracture diagnosis has been made, you may need other tests (such as a MRI, or angiogram which is a special X-ray of blood vessels) to determine whether other tissues around the bone have been damaged.
A fracture often requires emergency treatment at a hospital. An example of a minor fracture that may not require emergency care is a fracture of the tip of a toe. If you think that bones may be broken in the back, neck, or hip, do not move the person; instead, call for emergency medical assistance. If the person is in shock (faint, pale, or breathing shallowly), call for emergency help, lay the person down, and raise his or her legs about eight to 12 inches unless you think leg bones may be broken.
Different types of fracture include:
Closed (simple) fracture – the broken bone has not pierced the skin
Open (compound) fracture – the broken bone juts out through the skin, or a wound leads to the fracture site. Infection and external bleeding are more likely in open fractures.
Greenstick fracture – a small, slender crack in the bone. This occurs in children because their bones are more flexible that adult’s bones.
Stress (Hairline) fracture – the most common form is a stress fracture occurs in the foot or lower leg as a result of repeated stress from activities such as jogging or running.
Complicated fracture – structures surrounding the fracture are injured. There may be damage to the veins, arteries or nerves.
Comminuted fracture – the bone is shattered into small pieces. This type of complicated fracture tends to heal more slowly
Avulsion fracture – muscles are anchored to bone with tendons, a type of connective tissue. Powerful muscle contractions can wrench the tendon free and pull out pieces of bone. This type of fracture is more common in the heel, knee and shoulder joints
Compression fracture – occurs when two bones are forced against each other. The bones of the spine, called vertebrae, can have this type of fracture. Older people, particularly those with osteoporosis, are at higher risk.
Not all fractures are of a person’s arm or leg. Trauma to the head, chest, spine or pelvis can fracture bones such as the skull and ribs. These fractures are further complicated by the underlying body structure that the bone normally protects. Some of these fractures can be very difficult to manage using first-aid principles only as they may represent life-threatening injuries. Always seek emergency assistance if you suspect this type of fracture.