Skip to main content

Health condition · Clinically reviewed

Fractures and broken bones, first aid, urgent care and getting back on your feet.

From a hairline stress fracture to a displaced open break, the plan is the same in spirit - protect, image, reduce, fix, rehabilitate. And for anyone over 50, prevent the next one. Also see our companion guide at /conditions/fracture/.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

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 NICE, BOAST and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including BOAST 4 open fracture pathways and fragility fracture care.

Key facts

Fractures at a glance.

The essentials, in plain English - the main types, the top red flags and what modern UK care looks like. For the full clinical guide, see /conditions/fracture/.

  • What it is

    A fracture is a break in the continuity of a bone, from a hairline crack to a complete displaced break.

  • Types

    Traumatic, stress, pathological, insufficiency and fragility fractures - each with a distinct cause and workup.

  • Common sites

    Wrist, ankle, hip, vertebra, clavicle, hand and foot - the top-five UK adult fracture sites.

  • First aid

    Rest, ice, compression, elevation (RICE), splint the limb and seek urgent assessment for suspected fractures.

  • Open fractures

    Any bone exposed through skin is an emergency - BOAST 4 pathway with antibiotics inside an hour.

  • Fragility fractures

    A low-energy fracture after age 50 is osteoporosis until proven otherwise - a Fracture Liaison Service (FLS) assessment is standard.

Why this guide matters

Three ideas that shape every fracture plan.

Broken bones are common, but the small decisions in the first hours - and the year that follows - decide whether you heal well and stay well.

  • The mechanism tells the story

    A high-energy crush and a low-energy trip need very different workups - the injury story shapes imaging, fixation and follow-up.

  • Time-critical windows exist

    Open fractures need antibiotics within an hour; hip fractures need surgery within 36 hours; compartment syndrome is measured in minutes.

  • A fragility fracture is a warning

    Break a bone from a low fall after 50 and osteoporosis is the working diagnosis - a DEXA scan and bone-active therapy prevent the next one.

How the diagnosis is made

From injury to a definitive plan.

The steps an Emergency Department or orthopaedic team will normally follow, in order - so you know what to expect at every stage.

  1. 01

    Assessing

    History and mechanism

    How the injury happened, the force involved and any pre-existing bone disease shape the differential from the first minute.

  2. 02

    Assessing

    Focused examination

    Deformity, tenderness, swelling, neurovascular status and skin integrity - checked before any imaging is arranged.

  3. 03

    Assessing

    Plain X-ray, two views

    Two orthogonal views (AP and lateral) confirm most fractures and characterise the pattern and displacement.

  4. 04

    Confirming

    CT or MRI when needed

    CT for complex articular or spinal fractures; MRI for occult scaphoid, hip or stress fractures not seen on plain film.

  5. 05

    Confirming

    Orthopaedic review

    Displaced, articular, open or unstable fractures need same-day orthopaedic input for a definitive plan.

  6. 06

    Preparing

    Reduction and fixation plan

    Closed reduction and casting, percutaneous pinning, or open reduction and internal fixation (ORIF) - matched to fracture and patient.

  7. 07

    Preparing

    Fragility fracture workup

    Any low-energy fracture over 50: FLS referral, DEXA scan and consideration of bisphosphonates or denosumab.

Typical timeline: from injury to a definitive plan within hours in most UK Emergency Departments.

Types and patterns

Not all fractures are the same.

The five broad categories below drive the workup - and the fracture pattern (transverse, oblique, spiral, comminuted, greenstick) then shapes the fixation.

  • Traumatic fracture

    A clear high or moderate-energy event - falls from height, sports contact, road traffic collisions. The commonest category in younger adults.

  • Stress fracture

    Repetitive submaximal loading in bone that has not adapted - runners, dancers, military recruits. Insidious ache before a definite pain.

  • Pathological fracture

    Fracture through diseased bone - metastasis, multiple myeloma, primary bone tumour, Paget disease or a benign bone cyst.

  • Insufficiency fracture

    Normal load on abnormally weak bone - the classic sacral, pubic or vertebral fracture in osteoporosis.

  • Fragility fracture

    A low-energy fracture (fall from standing height or less) after 50 - the sentinel event for osteoporosis and a Fracture Liaison Service referral.

  • Paediatric patterns

    Greenstick, torus (buckle) and physeal (growth plate) fractures behave differently from adult bone and need paediatric orthopaedic input.

Symptoms

How a broken bone actually presents.

The classic mix of pain, swelling and loss of function - and the features that mean this is more than a simple soft-tissue injury.

  • Pain and tenderness

    Sharp, localised pain that worsens with movement or pressure over the bone.

  • Swelling and bruising

    Rapid soft-tissue swelling and haematoma around the fracture site within minutes to hours.

  • Deformity

    Visible angulation, shortening or rotation - a strong indicator of a displaced fracture.

  • Loss of function

    Inability to weight-bear on a leg or use an arm - a classic feature that raises fracture suspicion.

  • Crepitus

    A grating sensation as fracture ends move against each other - do not test for this deliberately.

  • Open wound over bone

    Any breach of skin near a suspected fracture is an open fracture until proven otherwise.

  • Neurovascular compromise

    Cold, pale, pulseless or numb limb distal to the injury is a surgical emergency.

  • Red flag - suspected spinal injury

    Midline spinal pain after trauma, weakness or altered sensation needs full spinal precautions and urgent imaging.

Treatment

How fractures are treated in the UK.

First aid on scene, closed reduction and casting for most simple fractures, and internal fixation when anatomy or stability demand it - with a fragility-fracture safety net for anyone over 50.

  • RICE and splinting

    Rest, ice, compression, elevation and a well-padded splint stabilise the limb and reduce pain before hospital assessment.

  • Analgesia

    Paracetamol and NSAIDs for most fractures, with short-course opioids for severe pain - always with a plan to step down.

  • Closed reduction and cast

    Manipulation under analgesia or sedation followed by a plaster or fibreglass cast - the workhorse of undisplaced or reducible fractures.

  • Percutaneous pinning

    K-wires stabilise reduced fragments through small skin punctures - common for wrist and paediatric fractures.

  • ORIF (plates and screws)

    Open reduction and internal fixation restores anatomy for displaced articular or unstable fractures.

  • Intramedullary nailing

    A rod passed through the medullary canal - the standard for femoral shaft and many tibial fractures.

  • External fixation

    A temporary frame for open or contaminated fractures and damage-control orthopaedics in polytrauma.

  • Fragility fracture pathway

    FLS-led assessment, DEXA, calcium and vitamin D, and bone-active therapy (bisphosphonates, denosumab, romosozumab) to prevent the next fracture.

BOAST 4 - open fracture pathway

Time is tissue.

The British Orthopaedic Association Standard for open fractures (BOAST 4) sets a clear sequence: single-shot IV antibiotics within one hour of injury, photograph the wound, saline-soaked dressing, splint and analgesia, tetanus cover, senior orthoplastic review, and time-critical debridement within 12 to 24 hours depending on contamination. Definitive skeletal stabilisation and soft-tissue cover follow, ideally at the same operation in specialist centres.

Fragility fracture pathway

Fix the fracture, then fix the bone.

Every low-energy fracture in an adult over 50 triggers a Fracture Liaison Service (FLS) review: a DEXA scan, a falls and vitamin D assessment, and a FRAX-based fracture risk score. Most patients are then started on a bisphosphonate (oral alendronate or IV zoledronate), with denosumab or romosozumab reserved for those at very high risk or intolerant of first-line therapy. Combined with calcium, vitamin D, strength training and a falls plan, this halves the risk of a second fracture.

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

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

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

  • British Orthopaedic Association (BOA). BOAST 4 - Open Fractures.

  • Royal Osteoporosis Society. Clinical guidance and Fracture Liaison Service standards.

Red flags

When a fracture is an emergency.

Most fractures are managed on the same day and heal without incident. These are the situations that need immediate escalation.

  • Open fracture

    Bone exposed through skin - IV antibiotics within one hour, tetanus cover, urgent orthoplastic review under BOAST 4.

  • Neurovascular compromise

    Pale, cold, pulseless or numb limb - suspect arterial injury or evolving compartment syndrome and escalate immediately.

  • Compartment syndrome

    Pain out of proportion, pain on passive stretch, tense compartments - a surgical emergency needing fasciotomy.

  • Cauda equina after spinal injury

    Saddle anaesthesia, urinary retention or bilateral leg weakness needs immediate MRI and spinal surgical input.

  • Hip fracture in older adults

    Groin pain and shortened, externally rotated leg after a low fall - admit for surgery within 36 hours per NHFD standards.

  • Suspected scaphoid or occult hip

    Normal X-ray does not rule these out - MRI within 48 to 72 hours is the standard if clinical suspicion persists.

  • Pathological fracture

    Fracture through abnormal bone - consider metastasis, myeloma or primary bone tumour and stage before fixing.

  • Stress fracture with red flags

    Female athlete triad, RED-S, high-risk sites (femoral neck, anterior tibia, navicular) need protected weight-bearing and specialist input.

  • Non-accidental injury

    Fractures inconsistent with the history, multiple fractures at different stages or in non-mobile children - safeguarding referral.

Living with it

Rehabilitation is where good outcomes are made.

The fixation gets you back to a stable skeleton. The next twelve weeks - protected range, progressive loading, nutrition and confidence - get you back to your life.

A quiet reminder

Consistency beats intensity, every time.

A short set of exercises done daily, for months, does more than a heroic gym week that leaves the limb swollen and sore.

  1. 01 Immobilise

    Protect while it heals

    A cast, brace or fixation lets the bone knit - keep it dry, elevate for the first 48 hours and follow weight-bearing advice.

  2. 02 Rehab

    Move early, load gradually

    Once safe, a physiotherapist rebuilds range, strength and confidence - most fractures need weeks of guided rehabilitation.

  3. 03 Bone health

    Fuel the repair

    Adequate protein, calcium and vitamin D, and stopping smoking, all measurably speed union and reduce non-union.

  4. 04 Prevent

    Stop the next one

    A fragility fracture doubles the risk of the next - DEXA, falls assessment and bone-active therapy make a real difference.

Frequently asked

Everything we get asked about fractures.

Quick answers on types, first aid, healing times, open fractures and fragility fracture prevention.

  • What is the difference between a fracture and a broken bone?

    Nothing - the two terms mean the same thing. A fracture is any break in the continuity of a bone, from a hairline crack to a complete, displaced or comminuted (shattered) break. See our clinical guide at /conditions/fracture/ for the full overview.

  • What are the main types of fractures?

    Traumatic fractures follow a clear injury. Stress fractures come from repetitive loading. Pathological fractures happen through diseased bone (cancer, myeloma, cysts). Insufficiency and fragility fractures happen through osteoporotic bone under normal loads - the classic older adult wrist, hip or spine fracture.

  • What should I do if I think I have broken a bone?

    Protect the limb with a simple splint (rolled magazine, sling, pillow), apply ice, elevate, and take paracetamol if you can. Do not eat or drink in case surgery is needed. Get to an Emergency Department the same day, or call 999 for open fractures, suspected spinal injuries, hip fractures or a cold, pale, numb limb.

  • What is BOAST 4 and why does it matter for open fractures?

    BOAST 4 is the British Orthopaedic Association Standard for the care of open fractures. It sets out photography and dressing of the wound, IV antibiotics within one hour, tetanus cover, senior orthoplastic review and time-critical debridement - the pathway that most reduces infection and amputation risk.

  • Why do I need a DEXA scan after a fragility fracture?

    A low-energy fracture in someone over 50 is osteoporosis until proven otherwise. A DEXA scan measures bone density and, combined with a fracture risk assessment, tells your team whether bone-active therapy (bisphosphonates, denosumab or romosozumab) is needed to prevent the next fracture. A DEXA scan is the entry point to our Fracture Liaison Service pathway.

  • How long does a fracture take to heal?

    Most simple upper-limb fractures unite clinically in 6 to 8 weeks; lower-limb fractures in 8 to 12 weeks; scaphoid, femoral neck and tibial fractures often need longer. Full return to sport can take 3 to 6 months. Smoking, diabetes and poor nutrition all slow healing.

Related content

Keep reading.

Pulse Healthcare concierge

Send us your enquiry

A concierge service for UK private healthcare. We match you with the best vetted clinics and consultants in our network - they then contact you directly.

So we can match you to the right clinician close to you.

We reply to every enquiry within 24 hours (Mon–Fri). Confidential - your details are never shared outside our vetted consultant network.