Increased pressure on the poultry industry by animal-rights organisations and environmentally-conscious consumers has led to the rising popularity of cage-free housing system for hens. One of the main dangers of cage-free housing systems is the possibility for laying hens to damage their keels. Keel bone fracture incidence rate ranges up to 85%, and can lead to extensive pain in any bird, and potentially be the cause of the death for a hen in a cage-free environment. It was reported that kneel bone damage observed in flocks housed in non-cage systems was 30 to 95% while in furnished cages it was 15 to 55%. The purpose of this review is to compare the prevalence of the problem found in the three main housing systems (conventional, enriched cage, and cage-free), discuss if such damage could affect the behaviour and production of laying hens, and provide potential solutions for reducing the prevalence of keel bone damage. Keel fractures can negatively affect a hen in its day-to-day life by causing pain and restricting its movements. The prevalence of keel bone damage varies considerably among the studies due to differences in the system design, genetic line, age and method for determining the keel damage, which makes difficult to compare the systems. The genetic selection, adequate nutrition and modifications in the house design have shown to be useful tools in reducing keel bone damage in laying hens.