How do I tell if a bone is broken, and what should I do?
The signs that suggest a fracture, why a small break can hurt very little, and the difference between a 999 injury, an A&E injury and something NHS 111 can direct.
- Difficulty
- beginner
- Time
- 7 min
- Read
- 4 min
- Safety
- warning
Short answer
Deformity, an odd angle, bone visible through the skin, numbness or tingling, or feeling cold, sweaty, faint or sick all point at a significant fracture. Support the limb and do not try to straighten it. Ice wrapped in a cloth helps. Nothing to eat or drink in case surgery is needed. 999 for severe injuries, a suspected hip, neck or back, or a limb that looks wrong; A&E for a suspected broken arm or leg; NHS 111 can direct for a finger or a toe.
It is genuinely hard to tell a bad sprain from a small fracture without an X-ray, and a small crack can hurt surprisingly little. What is worth knowing is which signs mean it is not a wait-and-see injury, and what makes the difference between calling an ambulance and going in.
Safety
Step by step
- Look for the signs that make it obvious.A limb that has changed shape or sits at an odd angle. Bone visible or breaking the skin. These are unambiguous and they mean 999.
- Look for the signs that are easier to miss.Tingling or numbness in the injured area, and the person feeling cold, sweaty, faint, dizzy or sick — which is shock rather than squeamishness. Both point at something significant.
- Accept that pain is a poor guide.NHS guidance notes that small breaks and cracks may not cause much pain and that people often do not realise they have broken a bone. Being able to move it or bear weight is not proof that nothing is broken.
- Support the limb where it is.Do not try to straighten it or push anything back. A towel used as a sling supports an arm; padding either side supports a leg. The aim is to stop the broken ends moving.
- Use ice properly.An ice pack or frozen peas wrapped in a cloth, over the injury, reduces swelling and pain. Never put ice directly on skin.
- Give nothing to eat or drink.NHS advice, because surgery may be needed to fix the bone, and an empty stomach matters for an anaesthetic. This is easy to get wrong while being kind.
- Choose the right route.999 for a severe injury, a visible bone, a deformed limb, a suspected hip, neck or back, or if you cannot get to A&E quickly. A&E for a suspected broken arm or leg. NHS 111 can direct you for a suspected broken finger or toe.
- Do not move a suspected neck or back injury.Ring 999 and keep them still and warm where they are, unless there is an immediate danger. This is the one situation where moving someone can turn an injury into a permanent one.
Tips
- Take a photograph of any obvious deformity before it is splinted or moved, if you can do it without delay. It is useful and nobody remembers accurately afterwards.
- Rings come off before the swelling arrives, not after. This applies to any hand or finger injury and it saves the ring being cut off later.
- In an older person, a fall with hip pain and an inability to weight-bear is a suspected hip fracture and an ambulance, even if they seem otherwise well.
Common mistakes
- Trying to straighten a deformed limb — It can damage blood vessels and nerves, and it is intensely painful. Support it as it lies and let the hospital do it under sedation.
- Giving them a cup of tea — It is the instinctive kindness and it can delay surgery. Nothing by mouth until they have been assessed.
- Deciding it is not broken because they can move it — People walk on broken bones regularly. Movement and weight-bearing do not rule out a fracture, and the assessment is an X-ray rather than a test at home.
- Driving someone with a suspected hip fracture — NHS advice for a broken hip is explicitly to ring 999 rather than drive. Getting them into and out of a car causes further damage and severe pain.
If it doesn't work
The skin beyond the injury is pale, blue or cold, or has no feeling
Cause: Possible damage to blood supply or nerves — Fix: Ring 999. Circulation problems below a fracture are time-critical and this is not something to take to a waiting room.
Bone is visible through the skin
Cause: An open fracture — Fix: Ring 999. Cover it lightly with a clean dressing, do not push anything back, and do not clean the wound. Infection risk is what makes this urgent as well as the fracture itself.
A wrist injury that is painful but usable a day later
Cause: Possibly a small fracture — scaphoid fractures in particular hide well — Fix: Get it X-rayed. Wrist fractures that are missed because the injury seemed minor are a recognised problem, and they heal badly when untreated.
Questions people ask
Can I tell a break from a sprain?
Often not without an X-ray. Deformity and visible bone are conclusive; everything else overlaps. If in doubt, get it looked at — a sprain assessed unnecessarily costs a few hours and a missed fracture costs far more.
What is a greenstick fracture?
A partial break in a child's bone, where it bends and cracks on one side rather than breaking through, because young bone is more flexible. It still needs treating.
Should I strap it up?
Support it, do not bind it tightly. Swelling under a tight strapping causes its own problems, and immobilisation is done properly at hospital after assessment.
How long before I can use it again?
That depends entirely on which bone and what treatment. The useful thing to do is follow the instructions from the fracture clinic, because premature use is a common cause of poor healing.