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Health condition · Clinically reviewed

Fracture, from a hairline crack to a surgical emergency.

A break in the continuity of bone. What matters most is the pattern, whether it is open, the state of the nerves and vessels, and the underlying quality of the bone.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BOAST, BOA and NICE standards you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK trauma pathways including open-fracture care and fragility fracture liaison services.

Key facts

Fracture at a glance.

The essentials, in plain English - what a fracture is, the main types, and how UK trauma services approach them today.

  • What it is

    A break in the continuity of bone. Very common across every age, from playground falls to fragility fractures in later life.

  • Traumatic vs fragility

    High-energy trauma in the young, low-energy fragility fractures in the older adult with osteoporotic bone.

  • Stress fractures

    Repetitive loading, classically the metatarsals in runners and the tibia in military recruits.

  • Pathological

    Fracture through diseased bone from metastases, primary tumours, Paget’s or infection.

  • Open vs closed

    An open fracture communicates with the skin and is a surgical emergency under BOAST 4.

  • Fragility pathway

    Every fragility fracture triggers a Fracture Liaison Service (FLS) referral for bone-health assessment.

Why this guide matters

A pathway, not just a plaster cast.

Modern fracture care runs on national standards - BOAST, BOA and NICE - designed to spot the emergencies early and treat the underlying bone, not just the break.

  • Open fractures move fast

    Antibiotics within an hour, tetanus and urgent debridement. Definitive care under a joint orthopaedic and plastic-surgery service.

  • Fragility fractures need workup

    A wrist or hip fracture after a low-energy fall is a diagnosis of osteoporosis until proven otherwise. FLS closes the loop.

  • Rehabilitation matters

    Union on X-ray is only half the goal - strength, range and confidence are what get patients back to normal life.

How the diagnosis is made

From the mechanism to a clear plan.

The steps a UK emergency and orthopaedic team will follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Primary survey (ATLS)

    Airway, breathing, circulation and a full trauma screen come first. Major trauma is treated before the fracture itself.

  2. 02

    Assessing

    Structured examination

    Inspection, palpation, neurovascular status, compartment checks and a spine assessment where the mechanism warrants it.

  3. 03

    Assessing

    Plain X-ray - two views

    Orthogonal views including the joints above and below the injury. The default first-line imaging for suspected fracture.

  4. 04

    Confirming

    CT or MRI where indicated

    CT for complex or intra-articular fractures and pre-operative planning. MRI for occult fractures, stress fractures and marrow assessment.

  5. 05

    Confirming

    Bloods for major trauma

    FBC, clotting, group and save or cross-match and electrolytes - guided by the injury and the patient.

  6. 06

    Preparing

    Specialist trauma and orthopaedic

    Early orthopaedic input for reduction, fixation and rehabilitation planning. Major trauma travels the network pathway.

  7. 07

    Preparing

    Bone-health workup if fragility

    DEXA, vitamin D, calcium and endocrine review through the Fracture Liaison Service after any low-energy fracture.

Typical timeline: a first presentation to a settled plan in hours to days for most fractures.

Symptoms

What a fracture actually feels and looks like.

Pain, deformity, swelling and loss of function are the core features. The neurovascular findings tell you how urgent it is.

  • Pain at the site

    Sharp, well-localised bony pain that is worse with movement and weight bearing.

  • Deformity

    Obvious angulation, shortening or rotation - especially in long-bone shaft fractures.

  • Swelling and bruising

    Rapid soft-tissue swelling and ecchymosis around the injury, sometimes tracking distally.

  • Loss of function

    Inability to weight-bear, grip or use the affected limb. A useful clinical marker of a significant injury.

  • Open wound over bone

    Any skin breach in the injured segment is treated as an open fracture until proven otherwise.

  • Neurovascular changes

    Numbness, weakness, pallor, cool skin or absent pulses - a limb-threatening finding needing urgent review.

  • Compartment symptoms

    Pain out of proportion, pain on passive stretch, tense compartments - compartment syndrome until proven otherwise.

  • Red flag - open or neurovascular

    Open fractures, compartment syndrome and neurovascular compromise are all surgical emergencies.

Treatment

How fractures are treated in the UK.

Reduce, hold and rehabilitate - with surgery reserved for displaced, unstable, open and pathological injuries under BOAST and BOA standards.

  • Analgesia and reduction

    Opioid, Entonox or a regional block, followed by closed reduction and splinting where the fracture is displaced.

  • Cast or boot immobilisation

    Undisplaced or reduced stable fractures - protected in plaster or a boot with a staged return to weight bearing.

  • K-wire fixation

    For small-bone and paediatric fractures - low-profile stabilisation while healing proceeds.

  • Plate and screw fixation

    Open reduction and internal fixation for displaced, articular and unstable diaphyseal fractures.

  • Intramedullary nailing

    The workhorse for femoral and tibial shaft fractures - load-sharing and early mobilisation.

  • External fixation

    For open fractures, damage-control orthopaedics and unstable injuries where soft tissues won’t tolerate a plate.

  • Open-fracture pathway (BOAST 4)

    Antibiotics within an hour, tetanus, urgent debridement, definitive fixation and plastic-surgery cover as a joint ortho-plastic service.

  • Fragility fracture pathway

    Fracture Liaison Service, DEXA, calcium and vitamin D, bisphosphonates and specialist bone-health follow-up.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your emergency team, GP or orthopaedic surgeon knows your injury and history and can tell you which parts apply to you. If in doubt, get seen.

  • British Orthopaedic Association. BOAST 4: Open Fractures.

  • British Orthopaedic Association. BOAST Standards for Trauma and Orthopaedic care.

  • NICE. Fractures (complex): assessment and management (NG37) and Fractures (non-complex) (NG38).

  • NICE. Osteoporosis: assessing the risk of fragility fracture (CG146).

  • Royal College of Physicians. Fracture Liaison Service (FLS) standards.

Red flags

When a fracture needs urgent attention.

Most fractures are stable and treated on standard pathways. These are the situations that aren’t - and where trauma or orthopaedic input can’t wait.

  • Open fracture

    Any wound communicating with the fracture. Antibiotics within an hour, tetanus and urgent joint ortho-plastic care under BOAST 4.

  • Compartment syndrome

    Pain out of proportion and pain on passive stretch in a tense compartment. Urgent fasciotomy - limb-threatening if missed.

  • Neurovascular compromise

    Absent pulses, cool pale limb or new neurological deficit. Immediate reduction, imaging and vascular or orthopaedic input.

  • Suspected spinal injury

    Any high-energy mechanism with midline pain or neurology - immobilise and image the spine before mobilising the patient.

  • Multiple or high-energy injuries

    Assume associated injuries and activate the major trauma pathway. ATLS principles come before the isolated fracture.

  • Fragility fracture

    Any low-energy fracture in an older adult is a sentinel event for osteoporosis - refer to the Fracture Liaison Service.

  • Pathological features

    Fracture through a lytic lesion, night pain, weight loss or a known malignancy - image and refer for oncology input.

  • Fat embolism syndrome

    Respiratory distress, confusion and a petechial rash after long-bone fracture - a medical emergency needing supportive care.

  • Non-accidental injury

    Unexplained fractures in children or vulnerable adults - safeguarding review is mandatory alongside the clinical care.

Living with it

A treatable injury, with a clear ladder.

Four things that make the biggest difference to fracture recovery - following the rehab plan, treating the underlying bone, returning gradually, and knowing what warrants review.

A quiet reminder

Union on X-ray is only half the goal.

Getting strength, range and confidence back matters just as much - and it takes weeks of steady rehabilitation, not a single follow-up.

  1. 01 Recovery

    Follow the rehabilitation plan

    Cast care, weight-bearing status and clinic reviews all matter. Rehab returns strength, range and confidence - not just union on X-ray.

  2. 02 Bone health

    Treat the underlying bone

    Fragility fracture is a diagnosis of osteoporosis until proven otherwise. Bone-health treatment prevents the next fracture.

  3. 03 Return

    Graded return to activity

    Runners with stress fractures come back through a graded loading plan - not straight back to previous mileage.

  4. 04 Warning

    Know the complication signs

    Worsening pain, colour change, numbness or fever after a fracture always deserves review - not another week of hoping.

Frequently asked

Everything we get asked about fracture.

Quick answers on emergencies, surgery, fragility fractures and long-term complications.

  • What is a fracture?

    A fracture is a break in the continuity of bone. It ranges from a hairline crack in a stress fracture to a comminuted, displaced injury after a high-energy mechanism. Every fracture is described by its site, pattern, displacement and whether it is open or closed.

  • What is the difference between a fracture and a break?

    They are the same thing. A "break" and a "fracture" both mean a disruption in the bone. The clinical difference is in the pattern - transverse, oblique, spiral, comminuted or segmental - and how the fracture is managed.

  • What makes a fracture an emergency?

    Open fractures, compartment syndrome, neurovascular compromise, unstable pelvic and spinal injuries and multiple injuries are all surgical emergencies. These need trauma pathway care and often theatre within hours.

  • How is a fragility fracture different?

    A fragility fracture is a low-energy fracture in bone weakened by osteoporosis or another disease. The injury itself often heals with standard care, but the underlying bone weakness needs its own workup through a Fracture Liaison Service.

  • Do all fractures need surgery?

    No. Many undisplaced and stable fractures are managed in a cast or boot with staged weight bearing. Surgery is reserved for displaced, articular, unstable, open or pathological fractures - and for cases where non-operative treatment would fail.

  • What are the long-term complications?

    Non-union, malunion, avascular necrosis, infection, complex regional pain syndrome (CRPS), stiffness and post-traumatic arthritis. Careful reduction, fixation and rehabilitation - and treating the underlying bone - reduce every one of these.

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