Is it possible to break a bone and not realise

The current state of the art in quantitative bone assessment is dual energy X-ray absorptiometry DEXA. This is done with a dedicated device about the size of a conventional radiographic examination table.

A scanning arm then passes over the patient and scans the area of interest. If a patient has more bone, then less X-rays make it through the patient into the X-ray detector. If less bone is present, then more X-rays make it through.

A computer attached to the device then takes this data, and uses it to create a transmission image of the bones of interest, and then compares this data with normative standards so that one can decide if the patient indeed has osteoporosis.

With chronic repetitive stress, one can break any bone in the body. However, this is more likely in certain bones, such as the tibial shaft, the metatarsal shafts, the femur, and the bones of the pelvis. If the fracture is fairly new, then there may be no plain film evidence of it. Later, once the fracture has been around long enough, periosteal reaction is often seen adjacent to the fracture site. A radionuclide bone scan or MRI can be used to screen for stress fractures.

This sounds ominous, and it kind of is. Crepitus is when you can feel crunchiness beneath your skin. However, if it does, then this is a sign there are broken pieces of bone rubbing against one another. In some cases, you may even see the bone poking out of the skin.

Ever hurt your hand as a child and a grownup asks you to move it? This is because broken bones lose their function. So if you were unable to move your hand, then this is a sign of a broken bone. The next time you hurt your arm or leg, try to wave or walk. Most broken toes can be taped to the toes either side and held steady in a special rigid shoe Credit: Alamy.

Likewise, fractures of the bone below the little toe on the outside of the foot can sometimes require surgery or a cast. Once more serious fractures have been ruled out, staff can splint broken toes for you and dress them with soft padding. This sounds too good to be true and, in the long-term, it is too good to be true. But there is some truth to it in the short term. While healing, a cuff or callous of extra-strong new bone forms around the fracture to protect it.

So, it is true that a few weeks into healing process, the bone at the break is stronger than a normal bone. Disclaimer All content within this column is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional.

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