Which of the following describes a closed fracture?

A closed fracture is specifically defined as a break in the bone where there is no associated open wound on the skin. This means that despite the bone being fractured, the integrity of the skin remains intact, preventing any external exposure of the fracture site. This can often reduce the risk of infection compared to open fractures, where the broken bone does protrude through the skin.

In regards to the other options, a broken bone that punctures the skin describes an open fracture, which is different as it involves a direct breach of the skin. A fracture requiring surgical intervention does not specifically define whether it is closed or open, as both types of fractures might require surgical treatment based on their severity. Lastly, a fracture that is not immediately visible on an X-ray typically refers to the difficulty in identifying certain types of fractures, but it does not define the fracture as being closed or open. Thus, the correct description of a closed fracture focuses solely on the absence of an external wound.