Did I Bruise My Bone or Break It?

The main difference between a fractured bone and a bone bruise is that a fracture results in an actual break in the bone and a bone bruise does not. However, the two have similar symptoms and causes, so it can be hard to tell if a bone is fractured or bruised without a physical examination or medical imaging (such as an X-ray or magnetic resonance imaging).

Fracture vs. Bone Bruise

The main difference between a bone fracture and a bone bruise is its severity. Bone bruises are far less severe and involve less tissue damage.

With that said, there is often a fine line between what might be considered a fracture or bruise, particularly when you have a smaller break like a hairline fracture (also known as a stress fracture).

Bone Fracture

A bone fracture, also called a "broken bone," occurs when a bone is damaged to the point where it cracks or breaks. Fractures range from relatively minor cracks, such as a hairline fracture, to a severe compound fracture where the broken end of a bone penetrates the skin.

Bone fractures are commonly caused by a fall or blunt force impact (such as a blow to the leg). They can also be caused by repetitive stress—such as repeated jumping or long-distance running—that creates tiny stress fractures. There are also pathologic fractures that develop when a disease like osteoporosis weakens a bone and makes it vulnerable to breakage.

What distinguishes a bone fracture is the amount of tissue that is damaged. This not only includes the hard outer shell of the bone, called the periosteum, but may also involve the spongy interior, called cancellous bone.

With a bone fracture, the damage is extensive enough to be seen on an X-ray.

Bone Bruise

A bone bruise, also known as a bone contusion, can also be caused by trauma, repetitive stress, or bone disease, but instead of creating a visible crack, the bone develops tiny micro-fractures that cannot be seen on an X-ray.

Even so, these "micro-cracks" can cause the pooling of blood, known as a hematoma. There may also be swelling between the bone and overlying cartilage.

If the hematoma develops in the periosteum, it is called a subperiosteal hematoma. If it occurs in the softer center of the bone, it is called an intraosseous hematoma. Those developing between articulated joints where there is bone and cartilage are commonly called subchondral lesions.

Bone bruises are more commonly seen with magnetic resonance imaging (MRI), an imaging tool that is best able to detect soft tissue injuries.

Although bone bruises may be less severe than bone fractures, they are no less concerning. This is because bone bruises can take a long time to heal and, unless properly treated, can compromise the bone and lead to an overt fracture.

Symptoms of Fracture

The symptoms of a fracture may vary depending on the extent and location of the break. In some cases, the break may be obvious or it may be so subtle that it is hard to recognize as a break.

Common symptoms of a bone fracture include:

• Swelling, bruising, or bleeding around the injured area
• Intense pain that may increase with movement
  
• Inability to move a limb or bear any weight
• A crunching sound or sensation when the bone is moved
• Visible deformity of a bone
• The protrusion of bone through broken skin

Symptoms of Bone Bruise

Symptoms of a bone bruise may be harder to recognize and, depending on its location, can easily be mistaken for a strain (involving muscles or tendons), a sprain (involving ligaments), or a ruptured ligament or tendon.

Symptoms of a bone bruise include:

• Pain and tenderness in the injured area
• Swelling and redness, particularly if a joint is involved
• A hard lump in the injured area
• Reddish or bluish discoloration
• Limited range of motion of the affected joint

Diagnosis

When diagnosing a fracture or a bone bruise, your healthcare provider will start by asking you questions about how and when the injury occurred as well as your symptoms. They will then do a physical examination of the area, looking for swelling, bruising, and tenderness.

Imaging tests are also helpful to differentiate between a fracture and a bone bruise. An X-ray can reveal a fracture, but an MRI is necessary to identify a bone bruise.

If your healthcare provider suspects you have a more severe fracture or your symptoms are caused by another problem, additional testing may be necessary.

Treatment for Fractures

Initial treatment for a minor fracture usually starts with the RICE protocol, a self-care method that involves:

• Rest: Avoid using the affected limb for at least 24 to 48 hours.
• Ice application: Apply an ice pack to the area for 20 minutes at a time, four to eight times daily.
• Compression: Compression with an ACE bandage can reduce swelling and pain.
• Elevation: Raising the affected limb above the heart can also reduce pain and swelling.

A splint may also be used to stabilize the bone while healing, while crutches may be recommended to reduce weight-bearing stress if the lower back, pelvis, hip, or lower limbs are affected.

Pain can also be controlled with Tylenol (acetaminophen). Nonsteroidal anti-inflammatory medications (NSAIDs) like Advil (ibuprofen) and Aleve (naproxen) are generally avoided as they can promote bleeding. Opioids are only used for severe fractures, often in combination with acetaminophen.

For more severe bone fractures, the orthopedist may recommend:

• Functional casting or bracing: This involves appliances like neck braces, knee braces, or hard-shell walking boots that are removable and help limit the movement of a joint during healing.
  
• Cast immobilization: This involves a fixed plaster or fiberglass cast that is continuously worn after the bone has been repositioned.
• Traction: This involves a pulley-like device and other appliances that ensure proper alignment of a bone using a gentle, steady pulling action.
• Open reduction and internal fixation (ORIF): This is a surgery that properly repositions (reduces) the bone fragments and then holds them with metal screws, plates, or rods.
• External fixation: This involves the insertion of metal pins or screws above and below the fracture site which are connected to a metal frame outside the skin that stabilizes the bone and holds it in the proper position.
  

Depending on the extent and location of a fracture, healing can take as little as six weeks or require months of recovery and rehabilitation time.

Treatment for Bone Bruise

The treatment for a bone bruise is comparable to treatment for a fracture. The RICE method is also recommended as the first-line approach. As with fractures, you may be advised to avoid NSAIDs which can make a hematoma worse and slow healing.

Depending on the location of the bruise, a splint, functional brace, or cast may be recommended. This is especially true if the bruise is in a location vulnerable to breakage or you have an underlying condition (like osteoporosis or osteopenia) that undermines the integrity of bones. Crutches may also be advised.

Most bone bruises heal within four to eight weeks.

Summary

A minor fracture (such as a stress fracture) can be hard to tell from a bone bruise because they cause similar symptoms, including swelling and pain. The main difference is that a fracture results in a break in the bone, while a bone bruise creates tiny cracks in the bone. Healthcare providers can tell the difference by using X-rays and MRIs. In most cases, bone bruises and fractures will heal within a month or two with conservative treatment.