How to tell if a bone is fractured or bruised

The easiest way to tell if you have a bone bruise or a fracture is to get an x-ray. An x-ray will usually show a fracture, but it doesn’t show bone bruises. As an orthopedic surgeon in Colorado Springs, Colorado, I frequently treat people who have both bone bruises and fractures (also known as broken bones). That being said, when you fracture some bones, you will know it! If you fracture your hip, arm, or leg, there is frequently some deformity and the pain is excruciating. You will normally not be able to bear weight on any major fractured bone without a lot of pain. However, there are smaller bones in the hand and foot that may be broken and not hurt terribly. There are also a group of fractures called stress fractures, which are true breaks and in some cases will not heal on their own without surgical intervention. Bone bruises usually occur from some obvious trauma, while stress fractures are more common after repetitive activities.

What’s the difference between a bone bruise and a fracture?

A bone bruise happens when you sustain trauma to a bone, but the forces aren’t enough to break it. The bone is still hurt and swells internally, but there is no clean break. Even though it may hurt, the bone is still structurally intact, and you can normally put weight on it as much as your pain tolerance will allow. The irritating thing about bone bruises is that they may take months and months to fully go away. Here in Colorado Springs, when I see someone with what I think is a bone bruise, I usually order an x-ray to make sure that we are not missing any fractures.

A fracture is when the bone breaks all the way through and there is evidence on imaging. Sometimes the bone is still well aligned after the fracture, and you won’t notice any deformity. Other times, the fracture is obvious because there is noticeable deformity. The treatment for a fracture depends on where it is located. Some bones heal well on their own or with casting, and others don’t.

Does a fracture always show up on x-rays?

The short answer is no. X-rays usually show fractures, but sometimes the crack is so small and the bone is well aligned that you can’t see it. In this case a CT scan can show the very fine details of a bone and determine if there is a fracture or not. MRI is not as good as a CT scan for finding a fracture, but it will show bruising of the bone which a CT scan will not do. As a practicing orthopedic surgeon out in Colorado, if I’m truly concerned about a fracture and don’t see one on x-ray, I will order a CT scan. 

I hope I was able to answer your questions about how to tell if a bone is bruised or fractured. f you would like me to treat your bone bruise or fracture, contact us below to make an appointment if you are in the Colorado Springs area. I also am available for virtual consults.

-Written by Dr. Daniel Paull

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