Fractures (Broken Bones)

Symptoms vary depending on the bone affected and the nature of the injury. Some fractures are immediately obvious; others — particularly stress fractures — may cause only gradual or activity-related discomfort.

Common symptoms include:

• pain at the site of injury, which may be severe or localised

• swelling and bruising

• tenderness to touch

• difficulty moving the affected area

• an abnormal appearance or deformity of the limb

• a snapping or cracking sound at the time of injury

• inability to bear weight on an affected leg or ankle

• numbness or tingling if nearby nerves are affected

If a fracture is suspected, prompt medical assessment is important. Continuing to use an injured limb without diagnosis risks worsening the injury and complicating recovery.

Common causes include:

• falls, particularly onto an outstretched hand or directly onto a joint

• sports injuries — contact sports, high-impact activities, or falls during sport

• road traffic accidents

• direct trauma or impact

• repetitive loading — running, jumping, or high-volume training, leading to stress fractures

Risk factors that increase fracture likelihood:

• low bone density (osteoporosis) — particularly relevant in postmenopausal women and older adults

• older age, where bone strength naturally declines

• relative energy deficiency in sport (RED-S) — associated with stress fractures in young athletes, particularly females

• nutritional deficiencies, especially low calcium or vitamin D

• certain medications — including long-term corticosteroids — that reduce bone density

• poor balance or mobility, increasing fall risk

• participation in high-risk sports or activities

Fractures are classified by their pattern and mechanism, which directly influences treatment decisions.

Stress fracture — a small crack caused by repetitive loading rather than a single traumatic event; common in runners and other high-volume athletes.

Greenstick fracture — the bone bends and partially breaks without fracturing completely; seen almost exclusively in children, whose bones are more flexible than adult bone.

Salter-Harris fracture — a fracture involving the growth plate (physis) in a child or adolescent; important to identify and manage carefully, as growth plate injuries can affect future bone development.

Transverse fracture — a straight break across the shaft of the bone.

Oblique fracture — a diagonal break, often caused by an angled force.

Spiral fracture — a twisting break caused by rotational force.

Comminuted fracture — the bone fragments into multiple pieces, typically from high-energy injury.

Compression fracture — the bone collapses on itself, most commonly seen in the vertebrae in the context of osteoporosis.

Avulsion fracture — a fragment of bone is pulled away at the point where a tendon or ligament attaches.

Open (compound) fracture — the broken bone pierces the skin, creating a risk of infection and requiring urgent treatment.

Closed fracture — the bone breaks without breaking the skin.

Any bone can fracture, but some are more commonly affected.

Upper body: wrist (distal radius), arm (humerus, radius, ulna), hand and fingers, collarbone (clavicle), shoulder.

Lower body: hip, thigh (femur), knee, shin (tibia and fibula), ankle, foot — including metatarsal stress fractures.

Spine and pelvis: vertebral fractures (particularly in osteoporosis), pelvis, ribs.

The location of a fracture is a key determinant of symptoms, treatment approach, and recovery time.

Children's bones differ from adult bones in important ways that affect both the types of fractures they sustain and how those fractures are managed.

Key differences in paediatric fractures:

• greenstick and buckle (torus) fractures are unique to children and reflect the relative flexibility of growing bone. Buckle fractures — where one side of the bone compresses without a complete break — are particularly common at the wrist after a fall and are generally stable, healing reliably with splinting

• growth plate (Salter-Harris) fractures occur at the cartilaginous growth plates present at the ends of long bones in children. These require careful assessment and appropriate management because poorly treated growth plate injuries can affect future bone growth and limb alignment

• Remodelling capacity — children's bones have a significant ability to remodel and correct themselves during growth. This means that some degrees of angulation or displacement that would require surgical correction in an adult may be managed conservatively in a child, with the expectation that normal alignment will be restored through growth

• non-accidental injury — any child presenting with an unusual fracture pattern, fractures at different stages of healing, or a history inconsistent with the injury must be assessed with this possibility in mind

At Welbeck, fractures in children are assessed by consultants with specific paediatric orthopaedic expertise, ensuring that the particular characteristics of the growing skeleton are fully taken into account.

At Welbeck, your consultant will take a detailed history of how the injury occurred and carry out a thorough physical examination of the affected area, assessing for swelling, tenderness, deformity, and neurovascular status.

Imaging investigations may include:

• X-ray — the standard first-line investigation; identifies the majority of fractures and guides initial management

• CT scan — provides detailed 3D imaging for complex fractures, particularly around joints or the spine

• MRI scan — the preferred investigation for stress fractures, growth plate injuries, and associated soft tissue damage

• ultrasound — useful in young children where radiation exposure should be minimised, and for assessing soft tissue structures

Traumatic fractures caused by accidents cannot always be prevented. However, maintaining bone health and reducing fall risk can significantly lower fracture likelihood.

Helpful measures include:

• a diet adequate in calcium and vitamin D to support bone density

• regular weight-bearing exercise, which strengthens bone

• appropriate protective equipment for sport and high-risk activities

• fall prevention measures in the home, particularly for older adults

• bone density assessment (DEXA scan) if osteoporosis is suspected or there is a family history

• avoiding smoking and excess alcohol, both of which reduce bone density

For young athletes, ensuring adequate nutritional intake and avoiding excessive training loads reduces the risk of stress fractures — particularly important in adolescent females at risk of RED-S.

Most fractures heal well with appropriate treatment. However, complications can occur, particularly with complex injuries, delayed diagnosis, or where underlying bone health is poor.

Possible complications include:

• non-union — the fracture fails to heal, often requiring surgical intervention

• malunion — the bone heals in an incorrect position, potentially affecting function and alignment

• infection — a risk particularly with open fractures or following surgery

• nerve or vascular injury — damage to nearby structures at the time of injury or due to swelling

• joint stiffness and reduced range of motion — particularly following prolonged immobilisation

• growth disturbance — in children following growth plate injuries

• post-traumatic osteoarthritis — where a fracture extends into a joint surface

• chronic pain — in a small proportion of patients, pain persists beyond normal healing

Early and accurate diagnosis, appropriate treatment, and a structured rehabilitation programme all reduce the risk of complications.

Treatment depends on the type, location, and severity of the fracture, and on the patient's age and overall health. At Welbeck, your consultant will recommend a personalised plan.

Immobilisation — a cast, splint, or brace keeps the bone in the correct position during healing. Many fractures — including the majority of paediatric fractures — heal reliably with immobilisation alone.

Reduction — where bone ends are displaced, they may need to be realigned before immobilisation. This can be achieved manually under local or general anaesthetic (closed reduction) or surgically (open reduction).

Surgery — indicated for unstable, displaced, or complex fractures that cannot be held in position with a cast alone. Fixation options include metal plates and screws, intramedullary nails (rods inserted into the bone), or external fixators. In children, implants are selected to avoid damage to the growth plates.

Pain management — appropriate pain medication throughout the healing phase, with anti-inflammatory medication used selectively depending on the fracture type and stage of healing.

Physiotherapy — an essential component of recovery, addressing joint stiffness, muscle weakness, and movement patterns once healing is sufficiently advanced. A structured rehabilitation programme supports return to full function and reduces the risk of re-injury.

At Welbeck, our orthopaedic consultants have broad expertise in the assessment and management of fractures across all age groups — from children with growth plate injuries to adults with osteoporotic or high-energy trauma fractures.

We understand that a fracture, however straightforward, is painful, disruptive, and worrying. Our approach ensures accurate diagnosis, a clear management plan, and a structured pathway to recovery.

If you have sustained a fracture — or suspect you may have — early specialist assessment ensures the correct diagnosis and the most appropriate treatment from the outset.

Get in touch today to book an appointment with one of our orthopaedic specialists.

We welcome paediatric patients aged 4 and above. For more information, please visit our Paediatric Orthopaedics page.

Our consultants are recognised by all major health insurance providers. We also offer care to self-paying patients. Learn more about payment options at Welbeck.