Understanding X-Rays of Broken Bones

Learn How to Understand a Report of a Fracture X-Ray

Patients with broken bones almost always have x-rays, and many words unfamiliar to patients may be used to describe these injuries.  Here are some of the common aspects of fracture x-rays that doctors assess.  Learn what they're talking about when they describe your fracture.

Fracture Location

intraarticular fracture x-ray
An intra-articular fracture of the tibia, where the fracture extends into the knee joint cartilage. Image © Jonathan Cluett, M.D.

The location of the fracture within the bone is the first part of most x-ray descriptions.  The most common words used to describe the location of a fracture include:

  • Diaphyseal: this means the shaft (center) of the bone.
  • Metaphyseal: toward one end of the bone, but not right at the joint.
  • Peri-articular: around the joint surface, at the end of the bone.
  • Intra-articular: the fracture extends into the joint through the cartilage surface.
  • Proximal: means closer to the center of the body (the upper end of the bone).
  • Distal: means further from the center of the body (the far end of the bone).

Fractures that involve the joint surface are often treated more aggressively, as imperfections in the alignment of a joint surface can lead to accelerated arthritis of the joint.

Fracture Alignment

tibia fracture x-ray
A diaphyseal tibia fracture with about 30% displacement, minimal angulation, and no shortening. Image © Jonathan Cluett, M.D.

The alignment of a fracture is the description of how far out of position the bone has shifted:

  • Non-displaced: means the fracture is visible, but the bone is in perfect alignment (this can also be called anatomic alignment).
  • Minimally displaced: slight shift in the position of the bone, but usually this is not significant.  Only in some specific fractures (e.g. intra-articular fractures) is minimal displacement a concern.
  • Displaced: this means the bone has shifted, and usually a report will comment on how much displacement has occurred.  Often displacement is measured relative to the width of the bone (for example, 100% displacement means the bone ends do not overlap, and have shifted completely apart).
  • Depression: refers to a joint surface (intra-articlar fracture) fragment that has been pushed out of alignment with the rest of the joint.
  • Angulated: refers to the alignment of the bone.  Angulation is typically measured in degrees.
  • Shortening: when a bone breaks, the bone ends may be pulled together by the muscles, causing the extremity to shorten.

Signs of High-Energy, Severe Injury

segmental fracture
SMC Images / Getty Images

There are certain words used to describe high-energy injuries that are created with significant force.  These words include:

  • Comminution: is a word that means to reduce the size of fragments--comminuted fractures have many small fragments, people often say there bone was "shattered."
  • Segmented: a segmental fracture is a bone that has multiple fractures.  For example, a femur fracture may occur at both the proximal (upper) and distal (lower) ends of the bone.  The central fragment is referred to as the segmental fragment.

Signs of Abnormal Bone

pathologic fracture x-ray
A pathologic fracture of the femur. Image © Jonathan Cluett, M.D.

Some fractures occur as a result of bone that is weakened, called pathologic fractures.  Pathologic fractures can be the result of bone thinning, tumors, infections, or other conditions the weaken the bone structure.

  • Osteopenia: means the bone density looks abnormal.  Note that osteoporosis should not be used to describe the x-ray appearance of bone; osteoporosis is a specific diagnosis made by bone density test, not an x-ray finding.
  • Cystic: cystic changes can occur as a result of some focal condition causing bone weakening.  These can include tumors and infections.
  • Lesion: a bone lesion simply means an abnormality of the bone that has not been defined--it does not necessarily mean something harmful.

Signs of Fracture Healing

tibia fracture
ZEPHYR / Getty Images

Broken bones usually show signs of healing within a few weeks of an injury.  Signs of bone healing may include:

  • Fracture callous: a fracture callous is the new bone growth seen around a break.  This often looks like a hazy bubble surrounding the injured bone.
  • Consolidation/Remodeling: consolidation is the finding consistent with later bone healing. Remodeling is the bone taking a more normal, pre-injury shape.  Children have a much higher capacity for bone remodeling than adults.
  • Delayed-union/Nonunion: occurs when the broken bone is not healing properly.  Reasons for nonunion include poor blood flow to the bone, infection, inadequate stabilization, and other causes.  Nonunions are much more common after open fractures.

Pediatric Considerations

Jonathan Kirn / Getty Images

Some findings are unique to broken bones in kids.  These include:

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