Fracture and suspected broken bone assessment (Assessment of a suspected fracture (including X-ray))
An examination and usually an X-ray to find out whether a bone is broken after an injury, and to decide how it should be treated.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- An X-ray is the main test for a possible broken bone, alongside a clinical examination — it shows many fractures and guides treatment.
- A bone through the skin, a deformed limb, severe bleeding, or a limb that is numb, cold or pale means call 999 or go to A&E now — do not move or straighten it.
- A normal first X-ray does not always rule out a fracture; some breaks need a repeat X-ray, a scan, or fracture-clinic review.
- How a confirmed break is treated depends on which bone, how badly it is broken, and whether it has moved out of position.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Finds out whether a bone is actually broken rather than guessing
An open fracture (bone through the skin), a clearly deformed limb, or severe bleeding — these need 999 or A&E, not a routine assessment.
You usually get the X-ray result and a plan — reassurance and advice if no fracture, or a support, cast, sling or referral if a bone is broken.
Clear advice on cast, splint, sling or crutch care and on warning signs.
You usually get the X-ray result and a plan — reassurance and advice if no fracture, or a support, cast, sling or...
Pain and swelling are often greatest early on. Rest, elevate and protect the limb; use pain relief as advised...
A broken bone is typically immobilised and reviewed in a fracture clinic. Many simple breaks heal in around 6 to 8...
If a fracture was suspected but not seen, you may have a repeat X-ray or scan after a week or two. Confirmed...
What is a suspected broken bone assessment?
A suspected broken bone (fracture) assessment finds out whether you have broken a bone after an injury and, if so, how serious it is. A clinician asks how the injury happened, examines the painful area — checking shape, swelling, tenderness, movement, feeling and circulation — and usually arranges an X-ray.
An X-ray is the main test for most broken bones. It shows many fractures clearly, helps decide whether the bone is in a good position, and guides treatment such as a plaster cast, splint, support, sling or, for some breaks, surgery. Not every fracture shows on a first X-ray, so sometimes a repeat X-ray, a scan, or review in a fracture clinic is needed.
This is not a substitute for A&E or 999. Some injuries need emergency care straight away: a bone sticking through the skin (an open fracture), a limb that is clearly deformed or at an odd angle, severe or uncontrolled bleeding, a limb or fingers/toes that are numb, cold, pale or turning blue, or a suspected broken hip, back, neck or skull. In these cases call 999 or go to A&E now, and do not try to move or straighten the limb yourself.
The assessment tells you what has happened and what to do next. A normal X-ray is reassuring but does not always rule out every injury, which is why clear follow-up advice matters.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Clinical examination
The clinician checks the painful area for deformity, swelling, tenderness, movement, and that the limb beyond the injury has normal feeling, circulation and skin colour. This...
X-ray
The main imaging test for most broken bones. Quick and low-dose, it shows many fractures and whether the bone is in a good position. Usually at least two views are taken.
Repeat or delayed X-ray
Some fractures — for example certain small wrist or foot bones — are not visible at first and show up on an X-ray repeated after a week or two, often arranged through a...
CT or MRI scan
Used in selected cases — complex fractures, joints, the spine, or when an X-ray is normal but a fracture is still suspected. Arranged by a specialist, not routine for every...
Preparing for your test
- For a serious or deformed injury, or a possible broken hip, back or neck, call 999 — do not travel or try to straighten the limb.
- If unsure where to go for a less severe injury, call NHS 111 in England, Scotland or Wales (in Northern Ireland, your GP out-of-hours service or your HSC Trust's Phone First service) to find a service that can X-ray.
- Note how the injury happened, when, and whether you could move or bear weight afterwards.
- Remove rings, bracelets or watches from an injured hand, wrist or arm before it swells.
- Do not eat or drink if a bone might need setting under sedation, until you have been assessed.
- Bring a list of your medicines, allergies and conditions, and mention if you might be pregnant before an X-ray.
- Bring someone to help you home, especially if you may end up with a cast, sling or crutches.
What happens
The clinician asks how the injury happened and examines the area, comparing it with the other side and checking movement, feeling, circulation and skin colour beyond the injury. This helps decide whether an X-ray is needed and where.
If an X-ray is arranged, a radiographer positions the injured part and takes images, usually from at least two angles. The X-ray is low-dose and quick; you may be asked about pregnancy first, and the rest of you can be shielded.
A clinician reviews the images with the examination findings and explains whether a bone is broken, whether it has moved, and what treatment is needed — for example a support, splint, cast, sling, crutches, or referral for a bone to be set or for surgery. If a bone needs straightening, the area is numbed (or you are given sedation) first.
You are given pain relief, advice on caring for any cast or support, and clear instructions about follow-up and warning signs. If the X-ray is normal but a fracture is still suspected, you may be treated as if it is broken and brought back for a repeat X-ray or scan.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- An open fracture (bone through the skin), a clearly deformed limb, or severe bleeding — these need 999 or A&E, not a routine assessment.
- A limb that is numb, cold, pale or losing movement — a possible blood-vessel or nerve problem needing emergency care.
- A suspected broken hip, back, neck or skull, or anyone who cannot move after a fall — keep still and call 999.
- A child with a possible fracture where the service cannot X-ray children or manage paediatric breaks.
Delay or rearrange if…
- The injury is severe or deformed — do not delay in a walk-in queue; call 999.
- You are unsure how serious it is — call NHS 111 first (in Northern Ireland, your GP out-of-hours service or your HSC Trust's Phone First service), or 999 if it feels serious.
- The service cannot X-ray your injury — find one that can before travelling.
- A bone may need setting under sedation and you have just eaten — tell the team so this can be planned.
Alternatives to discuss
- A&E or 999 for serious, deformed or open fractures.
- NHS 111 (in Northern Ireland, your GP out-of-hours service or your HSC Trust's Phone First service) to be directed to a service that can X-ray.
- Treating the injury as a sprain with PRICE and review if a fracture is thought unlikely.
- Repeat X-ray or CT/MRI through a specialist if the first X-ray is normal but a fracture is suspected.
- Fracture-clinic referral for ongoing assessment and treatment of confirmed breaks.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Finds out whether a bone is actually broken rather than guessing
- Shows whether a break has moved out of position and needs setting
- Guides the right treatment — support, cast, sling, crutches or surgery
- Picks up some injuries that need urgent or specialist care
- Gives reassurance and a clear plan if no fracture is found
Risks & complications
- A small dose of X-ray radiation (low, and weighed against the benefit)
- Discomfort when the injured part is moved for the X-ray
- Waiting time for the X-ray and for it to be reviewed
- Needing a follow-up appointment, repeat X-ray or fracture-clinic review
- A fracture not visible on the first X-ray, needing a repeat X-ray or scan
- An injury turning out to need a cast change, setting, or surgery
- A cast or splint causing pressure, rubbing or swelling that needs adjusting
- A significant fracture or associated injury under-recognised at first — safety-net advice is there to catch this
- Complications of a confirmed fracture such as poor healing, a blood clot, or nerve or blood-vessel involvement
The X-ray dose for a limb is small, but the more important issues are recognising serious injuries and knowing that a normal first X-ray does not always mean no fracture. Tell the clinician if the limb beyond the injury feels numb, cold or weak, if a cast feels too tight, or if pain is worsening rather than settling. Ask whether your X-ray showed a clear answer or whether you need a repeat X-ray or scan, and what warning signs mean you should seek urgent help.
Published figures to discuss
X-rays do not detect every fracture: some breaks, particularly small wrist (scaphoid), foot and hip fractures, can be missed on a first film and only show later, which is why suspected fractures are sometimes treated and re-imaged. X-ray radiation doses for limbs are low. Because detection depends on the bone, the injury and timing, reliable single percentages are not given here; the safe approach is careful examination, a low threshold to re-image, and clear safety-net advice.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Occult fracture despite initial X-ray | Recognised, especially scaphoid, hip, rib and stress fractures | Persistent focal pain or inability to weight-bear may need immobilisation and repeat imaging or CT/MRI. | NHS — Broken arm or wristnhs.ukSource-linked context |
| Compartment syndrome | Rare but limb-threatening | Severe escalating pain, pain on passive stretch, numbness or tense swelling after fracture needs emergency review. | Guide sourcesClinical context |
| Neurovascular injury | Uncommon but high impact | Documenting pulses, sensation, movement and capillary refill before and after splinting is essential. | NHS — Broken arm or wristnhs.ukSource-linked context |
| Fragility fracture indicating osteoporosis | Common in older adults after low-energy trauma | A fracture from a standing-height fall should trigger bone-health and falls assessment. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no recovery from the assessment itself. What follows depends on the result: reassurance and gentle return to activity if nothing is broken, or treatment and a healing period of weeks if a fracture is confirmed.
- Pain, swelling and bruising that ease over the first days to weeks
- Wearing a support, cast, sling or using crutches while a bone heals
- Stiffness in the joint after a cast comes off, which improves with gentle movement
- Waiting a short time for an X-ray to be reviewed or repeated
Aftercare
- Follow the advice for your injury, including how to use any cast, splint, sling or crutches.
- Keep an injured limb raised in the first days to ease swelling, and use pain relief as advised.
- Keep a plaster cast dry and do not push anything inside it; report a cast that feels too tight.
- Attend any fracture-clinic appointment, repeat X-ray or scan you are given.
- Gently move the joints around a cast (fingers or toes) as advised to keep them supple.
- Tell the clinician if pain worsens, the limb goes numb or cold, or fingers/toes change colour.
- Contact your GP, the service, or NHS 111 (in Northern Ireland, your GP out-of-hours service or your HSC Trust's Phone First service) if you are worried or things are not settling.
- Call 999 or go to A&E for any emergency warning sign you were told about.
- How and when you will get your X-ray result
- Date of any fracture-clinic or repeat-X-ray appointment
- Instructions for a cast, splint, sling or crutches
- A pain-relief plan suited to you
- A note of warning signs (tight cast, numb/cold limb, worsening pain)
- Someone to help you at home if you have a cast or crutches
⚠ Get urgent help if…
- A bone sticking through the skin (open fracture) — call 999, do not push it back
- A limb that is clearly deformed, at an odd angle, or that you cannot use — A&E now
- Fingers or toes beyond the injury that are numb, cold, pale, blue or losing movement — urgent help
- A plaster cast that becomes very tight, with increasing pain, numbness or tingling — seek help urgently
- Severe or uncontrolled bleeding with the injury — call 999
- Suspected broken hip, back, neck or skull, or you cannot move after a fall — call 999, keep still
- Pain that steadily worsens despite rest and pain relief
- A high temperature, spreading redness or pus around an open wound near the fracture
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result is a clear answer about whether a bone is broken and, if so, a plan to treat it so it heals in a good position. If no fracture is found, the result is reassurance plus advice on managing the injury and returning to activity.
An X-ray cannot show every injury. Some fractures are hidden at first, and X-rays do not show all damage to ligaments, cartilage or soft tissue. A normal X-ray therefore does not always mean nothing is wrong, which is why you may be treated cautiously and reviewed, and why warning-sign advice is important.
The assessment reflects the injury at that moment. A confirmed fracture is followed until it has healed, which takes weeks to months depending on the bone. A 'no fracture' result holds for that injury, but a new injury, or one that does not settle as expected, may need reassessing — pain that is not improving after a couple of weeks should be checked again.
Related tests, treatments or support
A fracture assessment often goes with other steps: pain relief and a cast or support, a tetanus booster if there is a wound, physiotherapy after healing, and fracture-clinic review. For complex breaks, CT or MRI and orthopaedic surgery may follow. In England, Scotland or Wales, NHS 111 can help direct less severe injuries to a service that can X-ray; in Northern Ireland, your GP out-of-hours service or your HSC Trust's Phone First service can do this.
Follow-up & long-term care
Follow-up depends on the result. A confirmed fracture is usually reviewed in a fracture clinic to check position and healing and to change casts. A suspected but unconfirmed fracture may be brought back for a repeat X-ray. You should leave knowing how to get your result, when any review is, and who to contact if things worsen.
Repeat, follow-on and what comes next
- A fracture not seen at first may need a repeat X-ray or a scan after a week or two.
- A break thought to be stable may move and need setting or surgery on review.
- A cast or splint may need changing as swelling settles or if it does not hold the bone well.
- Some fractures heal slowly or in a poor position and need further treatment.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear advice on cast, splint, sling or crutch care and on warning signs.
- A definite plan for follow-up, repeat X-ray, or fracture-clinic review.
- A named contact route and a low threshold to be seen again.
- Honest explanation that a normal X-ray does not always rule out a fracture.
- Onward referral to orthopaedics or physiotherapy where the injury needs it.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether you use a free NHS service or a paid private clinic
- The clinician assessing you and whether an X-ray is needed
- The X-ray itself and its reporting by a radiologist
- Any further imaging such as CT or MRI
- A cast, splint, sling, boot or crutches
- Follow-up in a fracture clinic, repeat X-rays and any cast changes
- Referral for setting a bone or for surgery if needed
- The fee for the assessment and any X-ray, including reporting
- The cost of further scans (CT or MRI) if needed
- Casts, splints, slings, boots or crutches
- Whether follow-up reviews, repeat X-rays and cast changes are included
- How and when you will get your X-ray result
- What happens, and what it costs, if the X-ray is inconclusive
- What happens, and what it costs, if you need setting or surgery
On the NHS? Assessment and X-ray for a suspected broken bone are provided free on the NHS at A&E, urgent treatment centres, minor injuries units and fracture clinics; private clinics charge a fee, but serious or deformed injuries should go to A&E or 999.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being reassured by a normal X-ray without being told some fractures are missed at first.
- No clear plan for a repeat X-ray or scan if a fracture is still suspected.
- No advice on the warning signs of a too-tight cast or a limb losing its blood supply.
- Not being told who reviews the X-ray and how you will get the result.
- No clear referral route if the break needs setting, surgery or fracture-clinic care.
Marketing red flags
- A private clinic implying it can manage serious or open fractures that belong in A&E.
- Promising a same-day definite answer when some fractures cannot be seen at first.
- Pushing extra scans that are not clinically needed for a simple injury.
- No clear arrangement for fracture-clinic follow-up or specialist referral.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Does my injury need an X-ray, and can you do one here?
- Did the X-ray give a clear answer, or do I need a repeat X-ray or scan?
- Is the bone in a good position, or does it need setting or surgery?
- How should I care for my cast, splint, sling or crutches?
- What warning signs mean I should seek urgent help?
- When and where is my follow-up or fracture-clinic appointment?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Can a minor injuries unit X-ray a possible broken bone?
Is it broken or just sprained?
Will the X-ray definitely show a fracture?
Is the X-ray radiation dangerous?
What happens if a bone is out of position?
How long does a broken bone take to heal?
Who do I call for urgent advice if I'm not sure it's an emergency?
My cast feels tight — what should I do?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Broken arm or wrist NHS — Broken ankle NHS — Broken leg NHS — When to visit an urgent treatment centre, walk-in or minor injury unit NHS — X-ray NHS 111 online nidirect — Urgent and emergency care services (Northern Ireland) nidirect — GP out-of-hours service (Northern Ireland)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Surgery to fix a broken bone · Sprains and strains · Minor injuries treatment · Urgent care / walk-in assessment · X-ray