How to read a fracture X-ray
Other platforms explain it with text and video. In VMS you practice it on the patient.
A clear fracture description lets the team decide on splinting, reduction or surgery. A simple order also helps you catch the fracture you were not looking for.
Step by step
Check the views
Get at least two views at right angles. For long bones, include the joint above and below. [1]
Name the bone and site
Say which bone, which side and where: near end, shaft or far end, and whether the break enters a joint. [2]
Describe the pattern
Use simple terms: transverse, oblique, spiral, comminuted (many pieces) or impacted. [2]
Describe displacement
Say how much the pieces have moved, angled or shortened, describing where the far piece points. [2]
Check children differently
Look for growth plate fractures, buckle fractures and greenstick fractures, which can be subtle. [2]
Look for hidden signs
A raised fat pad at the elbow or a joint effusion can mean a fracture you cannot see. Suspected scaphoid fractures need splinting and repeat imaging. [2]
Check the whole film
Keep looking after the first break. Check skin for an open fracture and check pulses and nerves. [1]
Common errors
- Ordering only one view.
- Stopping after finding the first fracture.
- Sending home a suspected scaphoid fracture without a splint.
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
Facts and steps follow AAMC Core Entrustable Professional Activities (Core EPAs); NCCPA PANCE Content Blueprint. VMS is not affiliated with these organizations. Updated: 2026-10-11.