Medically reviewed by Prof. Dr. Aamer Nadeem Chaudhary, M.B.B.S., D.M.R.D., F.C.P.S. (Diagnostic Radiology), Consultant, Al-Nasar Lab & Diagnostic Centre. Updated September 2026.
Quick answer: X-ray is the first and usually the only test needed for a suspected fracture. At least two views are always taken, because a break can be completely invisible from one angle. Some fractures, particularly of the scaphoid wrist bone and the hip, can be missed on the first film and only appear a week or two later.
Book an X-ray: call 0300 0341944. Home and bedside X-ray is available across Lahore.
Why are two views always taken?
This is the single most important thing to understand about fracture X-rays.
An X-ray is a flat shadow of a three dimensional bone. If a crack runs in the same plane as the beam, it can be invisible. Rotate the limb ninety degrees and the same crack becomes obvious.
So the rule in every radiology department is a minimum of two views at right angles, usually front and side. For some areas a third oblique view is added. If you have ever wondered why the radiographer repositions your arm several times for what feels like one simple picture, this is why.
The same principle explains why the joint above and below a suspected fracture is usually included. A twisting force that breaks the ankle can also break the top of the fibula near the knee, and an image limited to the ankle would miss it entirely.
What does an X-ray show for bone injury?
| Finding | What it means |
|---|---|
| Fracture line | A visible break in the bone cortex |
| Displacement and angulation | Whether the bone ends have moved apart or tilted, which decides whether it needs setting |
| Comminution | The bone has broken into more than two pieces, usually a more serious injury |
| Dislocation | A joint out of position, often needing urgent reduction |
| Joint effusion | Fluid in a joint after injury, an indirect sign that a fracture is present even when the line is not visible |
| Growth plate injury | In children, a break through the growing part of the bone, which needs careful management |
| Healing callus | New bone forming, which confirms an older fracture and shows how healing is progressing |
| Bone quality | Thinned bone raising the possibility of osteoporosis behind a fragility fracture |
Which fractures are commonly missed on the first X-ray?
Honest answer: several, and knowing them prevents a great deal of harm.
- Scaphoid fracture of the wrist. The classic missed fracture. Pain in the hollow at the base of the thumb after falling on an outstretched hand. Up to a fifth of these are invisible on day one and appear only after seven to fourteen days. If suspicion is high, the wrist is splinted and reimaged, or MRI is used to settle it immediately
- Hip fracture in older adults. An undisplaced hip fracture can look normal. If someone cannot weight bear after a fall, a normal X-ray is not the end of the assessment. MRI or CT is indicated
- Stress fractures. Common in runners and military recruits. They typically appear only two to three weeks in, once healing bone becomes visible
- Rib fractures. Frequently invisible, though the treatment rarely changes, so imaging is aimed more at excluding lung injury
- Radial head fracture at the elbow. Often detected only by the fluid sign in the joint rather than a visible line
- Spinal compression fractures in osteoporosis, which can be subtle and are easily attributed to simple back pain
If your pain persists and your X-ray was reported as normal, that is a reason to return, not a reason to assume nothing is wrong.
When is CT or MRI needed instead?
CT is used when a fracture is known but the anatomy is complex, for example fractures involving a joint surface, the pelvis, the wrist bones, the face or the spine. Surgeons often need it for planning. CT also finds fractures X-ray cannot resolve.
MRI is used when the concern is soft tissue or when a fracture is suspected but not visible. It detects bone bruising and stress fractures earlier than any other test, and it is the answer for an occult hip fracture or a suspected scaphoid injury. It is also the test for ligament and cartilage damage, as covered in our knee MRI guide.
Our comparison of MRI and CT explains the choice in more detail.
What happens during the X-ray?
You will be positioned by a radiographer, sometimes in a way that feels awkward on an injured limb. Tell them if the position is too painful, because there is almost always an alternative view that answers the same question.
Each exposure lasts a fraction of a second. You are asked to keep completely still, since movement blurs the fine cortical detail where a hairline crack shows.
The radiographer stands behind a screen. This is routine protection for someone who performs many examinations daily, not an indication that the dose to you is significant.
How to prepare
- No fasting or preparation is needed
- Remove jewellery, watches and rings from the injured area. Rings should come off early, before swelling makes it difficult
- You may need to change into a gown depending on the body part
- Bring previous X-rays, particularly for follow up of a known fracture, since comparison shows healing
- Tell the radiographer if you are or might be pregnant
- Bring your referral letter, as it tells the radiographer exactly which views to take
X-ray at Al-Nasar Lab
Al-Nasar Lab & Diagnostic Centre has served Lahore since 1996 and holds ISO 15189:2022 accreditation from the Pakistan National Accreditation Council. X-ray is reported by consultant radiologists, with CT and MRI available at our Johar Town campus when further imaging is needed.
For patients who cannot travel after an injury, home X-ray for elderly and bedridden patients is available across Lahore. See also when you need a portable X-ray.
Contact us to book or find your nearest location.
Frequently Asked Questions
Can an X-ray miss a fracture?
Yes. Scaphoid wrist fractures, undisplaced hip fractures and stress fractures are the common examples. If pain persists despite a normal film, repeat imaging or MRI is appropriate.
Why do they take more than one X-ray?
Because a crack lying in the same plane as the beam can be invisible from one angle. At least two views at right angles are standard for any suspected fracture.
How soon after injury should I have an X-ray?
As soon as practical, so displacement can be assessed and treatment started. Some fractures only become visible one to two weeks later, which is why repeat films are sometimes arranged.
Do I need a CT or MRI as well?
Only if the X-ray is unclear, the fracture involves a joint surface or complex anatomy, or soft tissue injury is suspected. Most simple fractures need X-ray alone.
Is a fracture X-ray safe?
Yes. Limb X-rays use a very small radiation dose. Tell the radiographer if you are or might be pregnant so shielding and alternatives can be considered.
This article is for general information and is not a substitute for medical advice. Please discuss your results with a qualified doctor.
