What’s the Difference Between a Fracture and a Broken Bone?
⌚️ read time: 5 minutes
As you might imagine, I treat a lot of broken bones. Or is the correct term ‘fractures’?
I get asked all the time: ‘Dr. G, what exactly is the difference between a broken bone or a fracture?’
Alternatively, I’ve noticed many patients come to my office assuming they have one versus the other. They will even obsess over the distinction, hanging on my every word until I tell them which they have. I can only guess that this is because they believe in some meaningful difference between the two diagnoses that will actually determine their treatment and healing trajectory.
And it of course is not my patients’ fault! Please forgive me if any of this piece feels judgmental towards those who don’t know the difference, that is certainly not how this is intended.
I recognize that we (in medicine) have failed you.
Because even within the medical community outside of orthopedics (doctors who treat broken bones), this confusion permeates. So how would it not create confusion in those of you without a medical background?
The big reveal
The point of today's article is to (hopefully) put this all to rest.
Let me say this officially, loud and clear. There is no difference between a broken bone and a fractured bone.
I repeat.
There is no difference between a broken bone and a fractured bone.
These are interchangeable terms that have no meaning or predictive influence on the treatment or outcome of a broken bone.
So, why the confusion?
Here’s my best guess at where the confusion originates.
My guess is that the intent of using these words in different scenarios is to delineate between a bone that has simply broken into two pieces and not moved out of place — compared with one that is smashed or crooked.
Does that seem right?
Terms I hear for the former injury include a ‘crack’ or a ‘hairline fracture.’ This would be in contrast to terms for the latter such as ‘smashed’ or ‘shattered.’
While these sorts of fracture characteristics certainly do play a role in how they are treated (and what the outcomes may be), these characteristics are not appropriately captured by the terms ‘broken bone’ or ‘fractured bone.’
So while I have you here, I might as well break down common fracture (or broken bone…gosh, this is difficult, they’re the same thing!) patterns and how they are typically treated.
NEW RULES: For the rest of this piece, I’m going to use the terms interchangeably. Because that’s just what they are. 100% interchangeable.
Non-displaced fracture
The first broad injury category is a non-displaced fracture. This would be the situation I mentioned above where the bone essentially cracks, but the two broken ends do not move out of place. There are always exceptions, but the majority of these can be treated with some form of immobilization (a cast or a brace), without the need for surgery.
Displaced fracture
A displaced fracture, as you might guess, is the opposite of the above. In this type of injury, the bone ends are unstable after they break, and the bone ends either shift or tip out of alignment.
Whether these require surgery or not will depend on the area of anatomy (a wrist fracture versus a finger fracture), the degree to which the bones have shifted out of place, and whether the fracture line involves the joint surface (intra-articular fracture, see below).
Comminuted fracture
The next type is a comminuted fracture, which means ‘in many pieces.’
Picture grandma's vase that smashes on the floor 😭. That’s pretty much what happens.
As you can imagine, these are high-energy injuries that are difficult to reconstruct, even with surgery. While they often do better with surgery, these patients don’t always return to the same normal function they had prior to the injury.
Intra-articular fracture
The last general type of fracture to discuss would be an intra-articular fracture. This is a broken bone where the fracture line extends up and through the joint surface.
You may recall from our previous discussions that the joint is an incredibly smooth surface lined with a soft, elastic layer called cartilage. This layer allows for near frictionless motion between our joints as we move throughout our day.
You can imagine that violating that surface causes a lot of damage (image below — normal joint on the left, intra-articular fracture on the right).
If you combine the above terms and get a displaced intra-articular fracture, now that cartilage surface is not only violated but shifted out of place. If it heals in this crooked manner, the joint will become bumpy — a recipe for arthritis over time. For this reason, most intraarticular fractures will benefit from surgery, particularly if they are displaced.
And that brings me to my last point.
The above categories overlap and can be combined. Perhaps the evil villain of all fracture types would be the displaced, comminuted, intra-articular fracture. Compare that with a non-displaced fracture and you can quickly get a sense that these injuries all behave quite differently…
Takeaways:
There is zero difference between the terms ‘broken bone’ and ‘fractured bone.’
I suspect the intent in differentiating these terms is actually an attempt to convey the difference between a non-displaced and a displaced fracture.
Classifying broken bones is one of my primary tasks — determining what type of fracture a patient has will often determine what treatment they need and what outcome they should expect.
Hopefully this clarifies things, at least a little. That’s my goal here, to make things easier to understand, even if little by little.
While there is no meaningful distinction between a broken bone and a fractured bone, there are important categories of fractures outlined above that will help your physician determine whether a broken bone can be treated with and without surgery.
