Overview
A fracture is a break or crack in a bone, ranging from small stress fractures and hairline cracks to compression fractures of the spine and complete breaks of the arm or leg. Fractures can result from a single high-force injury, repetitive overloading of bone (stress fractures), or weakening of the bone from osteoporosis or other medical conditions (fragility fractures). Most fractures heal well with appropriate immobilization, protected weight bearing, and a structured return to activity, while some require additional procedures depending on location, displacement, and stability.
Symptoms
Symptoms commonly include localized pain that is worse with movement or weight bearing, swelling, bruising, and tenderness directly over the bone. Many fractures cause visible deformity, limited motion, or an inability to use the limb normally; others, like stress and compression fractures, can present with more gradual aching pain that worsens with activity. In the spine, compression fractures often cause sudden mid- or lower-back pain that worsens with standing, bending, or lifting. Numbness, tingling, or weakness can occur if a fracture irritates a nearby nerve.
Causes
Fractures most often result from falls, motor vehicle collisions, sports injuries, or direct blows that exceed the bone's strength. Stress fractures develop from repetitive submaximal loading, such as a sudden increase in running, jumping, or marching volume. Fragility fractures occur with relatively minor force in bones weakened by osteoporosis, long-term steroid use, or certain medical conditions. Pathologic fractures can occur in bone affected by tumors or infection, even without significant trauma.
Risk Factors
Risk increases with age, low bone density, prior fracture history, smoking, heavy alcohol use, and chronic conditions or medications that weaken bone. Athletes who rapidly increase training intensity or volume face higher stress fracture risk, especially with poor footwear, hard surfaces, or biomechanical issues. Falls risk rises with balance problems, vision changes, certain medications, and household hazards. Postmenopausal women, those with low body weight, and people with vitamin D or calcium deficiency are at higher risk for fragility fractures.
Prevention
Prevention focuses on bone health (adequate calcium, vitamin D, weight-bearing exercise, and not smoking), fall prevention, and gradual progression of training to avoid overuse injury. Bone density testing is recommended for postmenopausal women and other higher-risk groups so osteoporosis can be identified and treated before a fracture occurs. Athletes can reduce stress fracture risk by varying activities, allowing recovery days, and addressing nutrition, footwear, and biomechanics. Helmets, seatbelts, and appropriate protective equipment lower the risk of fracture from collisions and falls.
How the Diagnosis Is Evaluated
Evaluation begins with a focused history of the injury or pain pattern and a physical exam looking for tenderness, swelling, deformity, range of motion, and neurovascular status. X-rays are usually the first imaging study and identify most acute fractures, though early stress fractures and some hairline or compression fractures can be missed. MRI or CT is often used when X-rays are inconclusive, to assess soft tissue or nerve involvement, or to plan treatment for complex injuries. Bone density testing (DEXA) may be ordered after a fragility fracture to evaluate underlying osteoporosis.
Nonsurgical Treatment Options
Most fractures are managed with a combination of immobilization, protected weight bearing, pain control, and a structured rehabilitation program once the bone has begun to heal. Casts, splints, walking boots, slings, and bracing are commonly used to keep the fracture stable while it heals, with the type and duration determined by location and stability. Pain may be managed with acetaminophen and, when appropriate, short courses of anti-inflammatory medications, along with ice and activity modification. Physical therapy plays a key role once healing allows motion, helping restore strength, balance, and function while reducing the chance of re-injury. For vertebral compression fractures, conservative care often controls symptoms; in selected patients with persistent pain, image-guided procedures such as vertebroplasty or kyphoplasty may be considered. Stress fractures usually heal with relative rest, activity modification, and a graduated return-to-sport plan. Underlying osteoporosis, when identified, is treated to reduce future fracture risk.
When to Seek Medical Attention
Seek emergency care for any open wound over a possibly broken bone, visible deformity, severe pain after trauma, inability to bear weight, or numbness, weakness, or color changes in the limb. Spine injuries with new bowel or bladder problems, leg weakness, or saddle numbness are emergencies. Get prompt evaluation for sudden severe back pain after a fall (especially in older adults or those with osteoporosis), increasing pain in a runner or athlete that does not improve with rest, or any pain that fails to settle in a reasonable period. Late evaluation can affect healing and outcome, so do not delay if symptoms are progressive.
Frequently Asked Questions
Healing time varies by location, severity, age, and overall health, but most simple fractures show meaningful healing within six to eight weeks, with full recovery often taking longer.
Yes, the majority of fractures heal with immobilization, protected weight bearing, pain management, and rehabilitation. Surgery is generally reserved for unstable, displaced, or specific high-risk fracture patterns.
A stress fracture develops over time from repetitive overload of bone, while a typical fracture occurs from a single higher-force injury. Both require medical evaluation and a structured recovery plan.
Next Steps
If you suspect a fracture, get a clinical evaluation and appropriate imaging promptly so the fracture can be stabilized and a recovery plan started. Once healing is underway, a structured rehabilitation program helps restore strength, balance, and confidence while reducing the risk of re-injury, and any underlying bone health issues should be addressed to lower future fracture risk.