Different Types of Fractures: Symptoms, Diagnosis, Treatment & Physiotherapy

Reviewed by the Physiotherapy Team at Waterloo Sports Medicine Centre  

A fracture is a break or crack in a bone, but not all fractures are the same. Learn about different types of fractures, what they can look like on an X-ray, how fractures are diagnosed and treated, typical healing times, and how physiotherapy can help you safely return to everyday activities, work, and sport. 

What Is a Fracture? 

A fracture occurs when a force applied to a bone exceeds its ability to withstand that force, resulting in a crack or break. The type and severity of a fracture are important because they help determine how the fracture should be treated and how much protection it needs while healing. 

What Are the Different Types of Fractures? 

Fractures can be classified in several different ways. Healthcare professionals may describe a fracture based on whether the bone has moved, whether the skin is broken, how many pieces the bone has broken into, and the shape or direction of the fracture line. 

By Alignment and Severity 

Stable or non-displaced fracture:  The broken pieces of bone remain in relatively good alignment. Many stable fractures can be treated with a cast, splint, or brace. 

Displaced fracture:  The bone fragments have moved out of their normal alignment. A displaced fracture may require reduction, which involves repositioning the bone fragments. Some displaced fractures require surgery to maintain proper alignment. 

Comminuted fracture:  The bone breaks into three or more pieces. These fractures can be more complex to stabilize and may occur following higher-energy trauma. 

By Whether the Skin Is Broken 

Closed fracture:  The bone is broken, but the skin over the injury remains intact. 

Open fracture:  The fracture is associated with an open wound that communicates with the broken bone. Open fractures require urgent medical treatment because of the increased risk of infection. 

What Are the Different Fracture Patterns? 

Transverse Fracture 

A transverse fracture travels approximately straight across the bone, creating a fracture line that is generally perpendicular to the long axis of the bone. 

Common mechanism: A force directed directly across the bone can produce this type of fracture. 

What it may look like on an X-ray: A relatively straight line crossing from one side of the bone to the other. 

Oblique Fracture 

An oblique fracture travels diagonally across the bone. 

Common mechanism: This pattern can result from a combination of bending and compressive forces. 

Spiral Fracture 

A spiral fracture wraps around the bone in a helical or spiral pattern. 

Common mechanism: It is commonly associated with a twisting force, such as the foot becoming planted while the body rotates. 

What it may look like on an X-ray: The fracture line may appear diagonal on one X-ray view and can be seen wrapping around the bone when multiple views are taken. 

Longitudinal Fracture 

A longitudinal fracture runs generally parallel to the long axis of the bone. 

Common mechanism: It can occur when force is transmitted along the length of the bone. 

What it may look like on an X-ray: A fracture line running lengthwise rather than across the bone. 

Avulsion Fracture 

An avulsion fracture occurs when a tendon or ligament pulls strongly enough to detach a small piece of bone where it attaches. 

Common mechanism: Sudden, forceful muscle contraction or a powerful ligament injury. 

These injuries can occur in sports and are more common around areas where tendons and ligaments attach to bone. 

What it may look like on an X-ray: A small fragment of bone separated from the main bone near a tendon or ligament attachment. 

Compression Fracture 

A compression fracture occurs when a bone collapses under compressive forces. 

They commonly affect the vertebrae of the spine, particularly in people with osteoporosis, although they can also occur following significant trauma. 

What it may look like on an X-ray: The vertebral body may appear shorter or compressed compared with its normal shape. 

What Does a Fracture Look Like on an X-Ray? 

X-rays are one of the most common ways to diagnose a fracture. They can show whether a bone is broken, where the fracture is located, and whether the bone fragments are aligned or displaced.  

Depending on the fracture, an X-ray may show: 

• A visible fracture line  

• A gap between bone fragments  

• Displacement or angulation  

• Multiple bone fragments  

• Changes in bone alignment  

• Hardware such as plates, screws, or rods following surgery  

What about stress fractures? 

Stress fractures are slightly different. 

An early stress fracture may not be visible on an X-ray. If clinical suspicion remains high despite a normal X-ray, your healthcare provider may recommend an MRI, which can identify bone swelling and stress-related changes that may not yet be visible on an X-ray.  

What Are the Symptoms of a Fracture? 

Symptoms vary depending on the location and severity of the fracture, but may include: 

• Sudden pain following an injury  

• Swelling  

• Bruising  

• Tenderness  

• Difficulty moving the injured area  

• Difficulty putting weight through the limb  

• Reduced strength  

• Deformity or abnormal positioning  

• A grinding or unusual sensation with movement  

A stress fracture may present differently, often causing localized pain that gradually develops or worsens with activity.  

How Are Fractures Diagnosed? 

Your healthcare provider will consider: 

• How the injury occurred  

• Your symptoms  

• The location of your pain  

• Swelling and tenderness  

• Your ability to move or bear weight  

• Circulation and nerve function

X-rays are typically the first imaging test used to evaluate a suspected fracture.  

Depending on the injury, additional imaging may be required. 

CT scan 

A CT scan can provide more detailed information about the fracture and may be particularly useful for complex fractures or fractures involving a joint.  

MRI 

MRI can be particularly useful for stress fractures or subtle fractures that may not be visible on an initial X-ray.  

Non-Surgical Treatment 

Some fractures can heal successfully without surgery. 

• Splinting  

• Casting  

• Bracing  

• Activity modification  

• Protected or limited weight-bearing  

• Gradual return to activity  

The purpose is to protect the fracture and maintain appropriate alignment while the bone heals.  

Reduction 

If the bone fragments are displaced, a healthcare provider may need to reposition the bones into better alignment. 

This can sometimes be performed without surgery, known as a closed reduction. 

The bone may then be protected with a cast, splint, or brace. 

Surgical Treatment 

Some fractures require surgery, particularly when the bone cannot be adequately aligned or maintained in position without fixation. 

Surgical options may include: 

• Screws  

• Plates  

• Pins  

• Rods or intramedullary nails  

• External fixation  

For example, some femoral shaft fractures are typically treated surgically with an intramedullary nail, while certain stable fractures can be managed without surgery.  

How Can Physiotherapy Help After a Fracture? 

 Your physiotherapist will work within the restrictions provided by your physician or orthopedic surgeon. 

1. Restoring Range of Motion 

Immobilization can cause joints and surrounding tissues to become stiff. 

Physiotherapy may include progressive exercises to restore: 

• Joint range of motion  

• Flexibility  

• Normal movement patterns  

The timing depends on the location and stability of the fracture. 

2. Rebuilding Strength 

Muscle strength commonly decreases while a limb is immobilized or used less. 

Your physiotherapist can progressively introduce: 

• Isometric exercises  

• Resistance exercises  

• Weight-bearing exercises  

• Functional strengthening  

• Sport-specific strengthening  

3. Restoring Balance and Coordination 

After a lower-limb fracture, balance and coordination may be affected. 

Rehabilitation can include: 

• Balance exercises  

• Proprioception training  

• Gait retraining  

• Single-leg control  

• Functional movement exercises  

4. Returning to Walking and Weight-Bearing 

Depending on the fracture, you may initially need: 

• Crutches  

• A walker  

• A boot  

• Partial weight-bearing  

• Non-weight-bearing  

Your physiotherapist can help you progress toward normal walking when medically appropriate. 

5. Returning to Work and Sport 

The final stages of rehabilitation focus on helping you return to the activities that matter to you.: 

• Running progression  

• Jumping and landing  

• Change-of-direction exercises  

• Work-specific lifting  

• Sport-specific drills  

• Progressive resistance training  

How Long Does a Fracture Take to Heal? 

There is no single healing time for all fractures. 

Healing depends on: 

• Type of fracture  

• Bone involved  

• Location of the fracture  

• Severity and displacement  

• Blood supply  

• Age  

• Overall health  

• Smoking status  

• Nutrition  

• Whether surgery was required  

Some fractures may heal in approximately 3–4 weeks, while others require 6–8 weeks or several months. More complex fractures may take considerably longer.  

Important: Bone healing ≠ complete recovery 

Even when the bone has healed sufficiently, you may still have: 

• Muscle weakness  

• Joint stiffness  

• Reduced balance  

• Reduced endurance  

• Difficulty with higher-level activities  

This is why rehabilitation can continue after the fracture itself has healed. 

For example, following a distal radius fracture, patients may experience wrist pain and stiffness for months and may require physiotherapy after the cast is removed.  

Looking for fracture rehabilitation or physiotherapy in Waterloo or Kitchener-Waterloo? Contact Waterloo Sports Medicine Centre to learn how physiotherapy can help you safely return to the activities you enjoy.