How to Recognize and Treat a Closed Fracture

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A closed fracture is a broken bone that does not penetrate the skin. This is an important distinction because when a broken bone penetrates the skin (an open fracture), urgent treatment is needed, and an operation is often required to clean the area of the fracture.

Closed fractures may still require surgery for proper treatment, but surgery is often not as urgent and can be performed in the days or weeks following the injury. Whether the fracture is closed or open, if you suspect you have a fracture, seek medical care.

This article will explain the signs and symptoms of a closed fracture, describe several types, and address diagnostic and treatment options.

x-ray of a closed fracture x-ray of a closed fracture
Matt Meadows / Getty Images

Signs of a Closed Fracture

There are several signs and symptoms that you might have a closed fracture. Signs of a fracture include:

  • Swelling
  • Pain
  • Bruising
  • Deformity
  • Lack of movement

Generally, there is pain around the injury, and you may be unable to move the affected area. The injury may also appear crooked and out of place. If the skin is broken over the injury, the fracture may be an open fracture, which carries a greater risk of infection.

Closed vs. Open Fracture

In an open fracture, the injury breaks the skin. You may or may not be able actually to see the bone. In a closed fracture, the skin remains intact.

Causes of Closed Fractures

Closed fractures can occur from a variety of different causes. The main causes are trauma, overuse injuries, osteoporosis, and pathological fractures.

Trauma

Fractures most often occur due to trauma or injury to the bone, such as a fall, motor vehicle collision, or sports injury.

Overuse

Fractures can also occur as a result of overuse. Overuse fractures are also known as stress fractures and occur due to excessive, repetitive use of the bone. They are common in athletes.

Osteoporosis

Osteoporosis weakens bones. Individuals with osteoporosis are more likely to experience a fragility fracture or an insufficiency fracture. A fragility fracture occurs with a low-impact activity that would typically not induce a fracture. An insufficiency fracture is a type of stress fracture.

Pathological

Weakening of the bone from various illnesses and disease states can cause fractures. These types of injuries are called pathologic fractures and typically result in a closed fracture pattern. Pathologic fractures occur when a bone weakens, typically from tumors or various cancers.

Types of Closed Fractures

There are several different types of fractures that can cause a closed fracture. The type of closed fracture you experience significantly affects how the fracture is treated. The types of closed fractures include:

  • Stable: The bones are barely out of place in a stable fracture.
  • Transverse: In a transverse fracture, there's a horizontal fracture line.
  • Oblique: In an oblique fracture, there's an angled fracture line.
  • Comminuted: In a comminuted fracture, the bone is shattered in several places.

Fracture types can be mixed. For example, you might have a stable transverse or oblique fracture.

You may also hear your healthcare provider use the terms "displaced" and "non-displaced" fracture. A displaced fracture means the bones are out of alignment. This type of fracture is more likely to require surgery. In a non-displaced fracture, the broken bones remain aligned. This type of injury is more likely to recover with a cast and immobilization and less likely to require surgery.

Locations of Closed Fractures

Fractures can happen throughout the body. Common locations of fractures can include bones of the wrist, hips, ankles, spine, and clavicle (collarbone).

Broken Wrist

A wrist fracture is one of the most common fractures in the United States. Closed wrist fractures can often be treated with a cast to hold the healing bones in the proper position. More severe wrist fractures may require surgery, even when the injury is closed. In these cases, pins, plates, and screws are commonly used for treatment.

Hip Fracture

A broken hip is usually a closed fracture and is common in individuals aged 80 and older. These are often closed fractures, as open hip fractures are exceedingly rare injuries. In older patients, osteoporosis causes hip fractures. Trauma, such as from a car accident, is usually the cause of hip fractures in other populations. Despite being a closed fracture, broken hips almost always require surgical treatment.

Ankle Fracture

Stress fractures are one of the more common ankle fracture types. Runners and athletes involved in sports that involve a lot of running (e.g., soccer and basketball) are especially susceptible to stress-related ankle fractures.

Trauma, such as from a car crash or fall, is another cause of ankle fractures. Other causes include twisting or rolling the ankle. Surgery may be needed depending on the type and severity of the injury.

Vertebral Compression Fracture

The spinal column is made of vertebrae stacked up upon each other. Osteoporosis can weaken the bones in the spinal column. Spinal compression fractures are most common in older individuals and often occur with relatively minor injuries or even no known injury at all. They are one of the most common complications of osteoporosis. Healthcare providers typically suggest nonsurgical treatments first before considering surgical intervention.

Clavicle Fracture

Clavicle fractures are another common fracture type. They occur in all age groups. In kids and adults, clavicle fractures are typically the result of a fall or accident. In babies, clavicle fractures can happen during childbirth. Most clavicle fractures can heal without surgery unless the bones have significantly shifted.

Diagnosing a Closed Fracture

A healthcare provider will do a physical exam and also likely order X-rays to diagnose a fracture. If a healthcare provider suspects a fracture but does not see one on an X-ray, they may order additional imaging, such as an MRI or CT scan.

A CT scan can provide more detailed pictures than an X-ray and may pick up small fractures more easily.

An MRI can show changes to the soft tissues as well as injury within the bone. Sometimes very small fractures do not show up on X-rays until the injury begins to heal. MRIs can show injury to surrounding structures that indicate there's a fracture, even if it is not easily detectable on an X-ray.

If a healthcare provider is concerned about additional injuries, such as blood vessel or nerve damage or an infection, they may order additional tests. Angiography is imaging, such as an X-ray or a CT scan, that is done after a contrast dye is injected. Angiography can show damage to blood vessels from a fracture.

A healthcare provider may order nerve conduction tests to assess for damage to nerves from a fracture.

Treating a Closed Fracture

Fracture treatment is highly dependent on several different factors. Factors such as patient age, patient preference, and surgeon preference play a role. Some of the treatments used for closed fractures include:

  • Immobilization Without a Cast: Not every fracture requires significant intervention. Some broken bones are stable injuries that can be managed without a cast or surgery. Durable medical equipment such as a boot, sling, or simply taping (e.g., buddy taping a broken toe to the toe next to it) might be enough.
  • Cast Immobilization: Casts are often used to treat many types of fractures. They help hold bones in proper alignment and protect the healing bone. Casts are used when bone immobilization is needed for several weeks.
  • Functional Cast: A functional cast is a special cast that immobilizes the injury while still allowing joint movement of nearby joints.
  • Internal FixationInternal fixation is a surgical procedure used to realign broken bones and then hold the healing bones in position with metal plates, pins, rods, or screws.
  • External Fixation: External fixation holds bones securely with metal screws or plates above and below the fracture. External fixation is used in situations where surgery is not an option.

How long does a closed fracture take to heal?

How long a closed fracture takes to heal depends on several conditions. Recovery can last from just a few weeks to several months, depending on your health, age, and the severity of your injury.

Summary

Closed fractures are when a bone breaks, but there is no break in the skin over the injury. There are several causes of closed fractures.

Whether a fracture is treated conservatively or with surgery depends on the injury's severity, the patient's health and age, and the provider's preference. Closed fractures are typically less emergent than open fractures due to the decreased infection risk.

Several treatment options exist, and surgery is not always necessary to align and heal the bones. If you think you might have a closed fracture, seek advice and treatment from a healthcare provider.

13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading
Cluett Cluett

By Jonathan Cluett, MD
Dr. Cluett is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the U.S. national soccer teams.