Hairline fracture?

  1. 0
    I had a pt who stated she fell over a week (on her knees coming down a step.) Turns out she has a hairline fracture of her tibia and didnt even know it? I have never heard of such a thing....can a person really do that and not notice it until a week later??

    Get the hottest topics every week!

    Subscribe to our free Nursing Insights newsletter.

  2. 12 Comments...

  3. 0
    Yes. It's a hairline fracture - they're very fine. You can have a hairline fracture for a long time and not know it - sometimes the only way you find out is when you do something that makes the fracture worse/bigger and you feel pain when it happens.
  4. 0
    Interesting....I would have thought that a person would have known right away. She said it didnt start hurting until a few days after! Ive never heard of such a thing!
  5. 0
    Oh, it's very easy to not know it.

    My sister, cousin, and myself have all had stress fractures of our tibias in the recent past. My sister and I had them in the same spot, even, right in the top of the shin under the knee. Both happened after we had started a jogging program.

    I'm a little surprised by HOW your patient got it, but that's neither here nor there. My guess is, she at least had pain, but didn't know she actually had a fracture. To make matters worse in that regard, stress fractures, especially there, often aren't seen on plain xray. My sis and I both needed MRI's to see ours. On the MRI they could see not only the fracture line, but a lot of edema in the bone itself (probably because I worked and walked on it for a month before it was diagnosed).

    After 4 times of hitting the treadmill at the gym, my knee was hurting. I figured that my poor old joints just weren't dealing well with my decision to exercise, because I didn't do it regularly. The pain just kept getting worse, though, over the course of the next week, to the point that even completely at rest it hurt badly (sitting in my car was torture). I couldn't lift my leg to get in to bed, I had to use my arms to lift it. I didn't know if it was a cartilage or ligament injury, or what (I suspected a stress fracture, because my symptoms were so similar to what my sister's were when she had hers, but the xray I had at my family doctor's office didn't show it). There was no real swelling, bruising, or anything when looking at it. I had to wait a LONG time to get in to my ortho (he's a busy guy), finally I was able to get in with an NP at that clinic after a few weeks. In the meantime, I had asked my family doc about walking on it, and since the xray was negative, she said it was OK to do. She even said exercise was OK, if I took it easy (ie, recumbent bike vs treadmill, to bear less weight). I saw the NP, then had to wait to get an MRI, then wait for the results. Once they had them, she said STOP walking on it!! There was a lot of fluid in the bone by then, as I said. I was non-weight bearing for a week or two, then had to restrict how much I walked on it. I was off of work for a total of two months, since they couldn't accomodate light duty. They can take several weeks to completely heal.

    My sister's experience, which was a year before mine, was almost exactly the same. Her first appt with her family doc, she had a negative xray as well, and they called it "overuse" and sent her on her way.

    LONG (sorry) story short....it's possible.
  6. 0
    Sure you can. Often you might have all outward signs/symp of a fx but nothing on the films. A few weeks later it might show on repeat film. Depending on the person/pain threshold and location of the fx it can go without notice. This can be bad of course because you do need to pay attention to it.
  7. 1
    It really does happen. The biggest problem with a hairline fracture is that they usually don't hurt much. So if you continue on as usual, you have a weak point in the bone that is now susceptable to even miniscule amounts of stress.

    A good example of this are the little elderly ladies. They fall, their hip hurts, so they are checked out. (Although I have seen some who never came if after the first injury- it didn't hurt.) Everything looks ok, and depending on how they feel they are admitted or sent home. We even CT some and find nothing acute. Usually within three days, if there is an occult fx, they stand up, have a sudden sharp pain and a new xray will now show an obvious new fracture.
    netglow likes this.
  8. 0
    I had a hairline fracture in my left calcaneus through all of basic training in the Army.

    Never had it casted, went through all of the training with it - while I definitely felt it (running 2 miles in under 13 minutes made me fall down and cry like a little girl when I was done) I made it through all of the rigorous training the Army could throw at me.

    Later I found out I had a stress fracture in the femoral neck of my right hip - which I never felt. It was the result of displacing so much weight to my right leg because of the fractures in my calcaneus.

    So yes, it's possible to have stress fractures and not know about them - or to chalk them up as painful sprains.
  9. 0
    Quote from RhiaRN75
    It really does happen. The biggest problem with a hairline fracture is that they usually don't hurt much. So if you continue on as usual, you have a weak point in the bone that is now susceptable to even miniscule amounts of stress.

    A good example of this are the little elderly ladies. They fall, their hip hurts, so they are checked out. (Although I have seen some who never came if after the first injury- it didn't hurt.) Everything looks ok, and depending on how they feel they are admitted or sent home. We even CT some and find nothing acute. Usually within three days, if there is an occult fx, they stand up, have a sudden sharp pain and a new xray will now show an obvious new fracture.
    I'll disagree with that!! Mine hurt a LOT, and the people that I know that have had them also said they hurt a lot. It was diagnosing them that was the challenge...

    I know not all will hurt, but I disagree with the term "usually."
  10. 0
    I tripped on a hole in the ground a couple years ago and thought I had sprained my ankle "a little." I mean, it hurt and it was swollen, but it was Thanksgiving and I wasn't about to the to the ER for it. I just wrapped it with an ACE and iced it. After about 5 days of that it still wasn't getting better, was black & blue, and I was limping, but I wasn't dying with pain. Mostly annoyed. Darned if I didn't have hairline fractures of the distal ends of both the tibia and fibula. Ended up in a cast for abou 6 weeks, non-weightbearing. Right at Christmas too! Boy, was I mad!
  11. 0
    I know not all will hurt, but I disagree with the term "usually."
    That's a good point. I tend to think of them in terms of the elderly and hips, so compared to a 'typical' hip fracture, they don't hurt much. For a while, anyhow. You're right though. I've seen them in all ages and sometimes the doc suspects a hairline fx based on the level of pain.

    Some of my elderly pts- man are they tough! They come in bewildered by it... "I fell a few days back, it didn't hurt much but when I go up this morning I don't know what happened!"

    Me- I broke my toe and freely admitted I was a drug seeker. I still worked, so in the end all I took was aleve but I was whining on the inside, lol.


Nursing Jobs in every specialty and state. Visit today and Create Job Alerts, Manage Your Resume, and Apply for Jobs.

A Big Thank You To Our Sponsors
Top