How to Tell If a Bone Is Fractured or Bruised

After a fall or sports injury, it can be difficult to tell if your child has a broken bone or a soft tissue injury, like a bruise, sprain, or strain. Understanding the difference can help you decide what to do next.

One of the first questions you may ask yourself is, “Do you have to rush to the emergency department, or can you just wait?” says Gleeson Rebello, MD, MBBS, a Mass General Brigham pediatric orthopedic surgeon.

While many soft tissue injuries can be treated at home, knowing the signs of a broken bone can help you quickly decide when to seek care.

Broken bone or soft tissue injury: What’s the difference?

Knowing whether your child broke something or just has a sprain or bruise starts with a basic understanding of each kind of injury.

Soft tissue injuries

A soft tissue injury affects muscles, tendons (which connect muscle to bone), or ligaments (which connect bones together). There are three main types:

1. Bruises: Also called contusions, bruises occur when blood vessels under the skin break.
2. Sprains: This injury is when a ligament stretches or tears, most commonly in the ankles, knees, and wrists.
3. Strains: Also known as a pulled muscle, these affect muscles or tendons.

Soft tissue injuries are very common in children, especially those who play sports. They can result from sudden trauma (such as a fall or collision), twisting a joint, or repetitive overuse.

Fractures

A fracture happens when a bone takes more force than it can withstand. In kids, broken bones often happen from falls, such as off playground equipment or a trampoline, or trauma from high-impact activities, like a collision on a bicycle or during sports. Children with poor nutrition, a diet low in calcium, or obesity have a higher risk of fracture.

Signs of a broken bone

Trying to assess an injury when a kid is in pain or upset can be challenging. And some fractures can be managed at home until you see a pediatrician, but others warrant a trip to the ER. Look for these telltale signs of a fracture that require urgent attention:

• Deformities: A broken bone that’s shifted out of place, causing an abnormal bump or bend in the body part
• Inability to move fingers or toes: Suggests a fracture or nerve damage
• Open fracture: A broken bone poking through the skin
• Unmanageable pain: Intense pain that doesn’t ease or go away

Signs of a soft tissue injury

Most soft tissue injuries can be managed at home with RICE (rest, ice, compression, and elevation) to reduce pain and swelling.

Symptoms of soft tissue injuries include:

• Difficulty moving
• Mild to moderate pain
• Swelling and bruising

When to go to the ER

Since fractures and soft tissue injuries have some symptoms in common, you may find yourself headed to urgent care or the ER for x-rays. If your child can’t put weight on the lower extremity or can’t use the upper extremity, if bleeding doesn’t stop, if pain gets worse in the hours after the injury, or the injured area shows signs of poor circulation (pale, cold, or numb)—or if you just aren’t sure what kind of injury it is—get it checked out.

The good news is that kids tend to heal quickly, Dr. Rebello says. “Children, more than adults, have a much better recovery. They usually don't have long-term ramifications of an injury.”