Understanding Bone Fracture X-Rays

Glossary of terms for the informed patient

When a person has a bone fracture, one of the first things a person will want to know is how bad it is. To determine the severity and treatment/recovery time, doctors will typically perform an X-ray. In some cases, they may use other imaging techniques, such as a computed tomography (CT) scan or magnetic imaging resonance (MRI), particularly it is a pathologic fracture. This is a type of break caused not by trauma but as a result of a medical condition which weakens the bone.

As a patient, you have the right to use to fully understand both your diagnosis and treatment options. To do so, you would be well served to understand the terminology used to describe a fracture.

Describing the Fracture Location

intraarticular fracture x-ray
Jonathan Cluett, MD

The anatomical location of a fracture is about more than just where the break is; it describes the structural characteristic of the break. To this end, doctors will typically use the following descriptive terms:

  • Diaphyseal: the shaft (center) of the bone
  • Metaphyseal: located toward one end of the bone but not at the joint
  • Peri-articular: located on the joint surface at the end of the bone
  • Intra-articular: a fracture which extends into the joint through the cartilage
  • Proximal: located closer to the center of the body at the upper end of the bone
  • Distal: located further from the center of the body at the far end of the bone

Fractures that involve the joint surface are usually treated aggressively as imperfections in the alignment can lead to accelerated arthritis in the joint.

Describing Fracture Alignment

tibia fracture x-ray
Jonathan Cluett, MD

The misalignment of a fracture tells us just how far out of position the bone has shifted. Doctors will describe this in the following terms:

  • Non-displaced: where the bone is fractured but in perfect alignment
  • Minimally displaced: where there is a slight shift in the position, usually not significant
  • Displaced: where the bone has significantly shifted, the degree of which is described in percentages
  • Depression: an intra-articular (joint) fracture which has been pushed out of alignment with the bone
  • Angulated: the angle by which the bones are misaligned, again described in degrees
  • Shortening: an effect caused when the surrounding muscles pull the bone ends together tightly, literally shortening the bone

Diagnosing Severe Fractures

segmental fracture
SMC Images/Getty Images

There are certain term doctors will use to describe fractures caused by a high-impact trauma such as a car accident or major fall. They include:

  • Comminution: a break or splinter of the bone into more than two fragments (colloquially referred to as a "shattered" bone)
  • Segmented: a bone break in which several large fragments separate from the main body of the bone

Diagnosing Pathological Fractures

pathologic fracture x-ray
Jonathan Cluett, MD

Pathologic fractures are caused when a bone weakens due to a disease that either displaces bone matter or interferes with the normal metabolism (remodeling) of a bone. Doctors will often describe these abnormalities as follows:

  • Osteopenia: a condition where the body doesn't make new bone as quickly as it reabsorbs old bone, oftentimes the result of a progressive disease like osteoporosis
  • Cystic: characterized by the formation of cysts as can happen with bone cancer and certain non-cancerous infections
  • Lesion: an unspecified abnormality which may be caused by bone damage or simply a past bone injury

Monitoring Bone Repair

tibia fracture
ZEPHYR/Getty Images

Broken bones usually show signs of healing within a few weeks of an injury. Doctors will describe this in terms that evaluate the progress of the repair. These include terms such as:

  • Fracture callous: new bone growth around a break considered a good sign that the bone fragments are reuniting
  • Consolidation: another term used to describe the normal process of bone repair due to remodeling
  • Delayed-union on nonunion: when the broken bone is not healing properly due to poor circulation, infection, inadequate stabilization, or other causes
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