Have you had a recent fall or do you practice sports frequently and notice persistent severe pain and swelling? Did you visit a doctor and your X-rays showed nothing abnormal?

It could be a hidden fracture - let me tell you about this pain that doesn't show up on X-rays

What is a hidden fracture?

It's an injury that shows no obvious signs and therefore goes unnoticed on simple X-rays. During your physical evaluation we perform specific movements and clinical tests to locate the pain.

Then we request advanced imaging studies such as:

1. Computed tomography (CT)
2. Magnetic resonance imaging (MRI) which has proven to be a highly sensitive imaging test for diagnosing these fractures due to its high resolution.
3. Bone scan which is an exam that detects bone abnormalities through injection of a radioactive tracer.

Most common areas for hidden fractures

Frequent areas include:

• Hip
• Spine
• Tibia (shinbone)
• Elbow
• Ankle
• Wrist

These last two, due to their anatomical complexity, are prone to unnoticed fractures. Women have greater predisposition due to hormonal factors like postmenopausal osteoporosis.

Hidden fractures can occur due to:

Trauma: Falls or direct impacts.

Risk factors:

1. Bone mass loss (osteoporosis)
2. Genetic diseases (osteogenesis imperfecta)
3. Rheumatoid arthritis
4. Hormonal disorders (amenorrhea, menopause)
5. Malnutrition or eating disorders
6. Excessive alcohol or tobacco consumption
7. Prolonged use of corticosteroids or anti-inflammatories
8. Chronic kidney failure

Key symptoms of a hidden fracture

1. Localized pain that persists even at rest
2. Constant swelling
3. Tenderness to touch in the affected area
4. Progressive functional limitation

Treatment

Varies according to the severity and location of the fracture:

1. Immobilization: Splints or cast
2. Weight offloading: Crutches or canes
3. Activity modification: Temporary sports rest
4. Supplementation: Calcium, vitamin D and bisphosphonates in cases of osteoporosis
5. Surgery: For unstable fractures or those with necrosis risk

It's important not to prolong and ignore discomfort for too long. While the body is very resilient and recovers on its own, sometimes this isn't enough and intervention is needed, either because the problem is more serious or because the body has reached its limit. In the case of hidden fractures, if not treated in time they can lead to complications like nonunion or deformities.

If you have more questions about this or would like to schedule an orthopedic consultation, I'd be happy to help. You can message me and I'll respond as soon as possible. You can find me at Torre Norte 2 in Tijuana, Baja California

If you don't live in Tijuana but would like to receive remote orthopedic advice, I'd be happy to help. You can schedule an appointment to begin at 664 169 0650