Term fracture,a break in the continuity of a bone, depicts all types of disruptions, from microscopic to severely comminuted injuries. Fracture description should be concise and accurate facts must be communicated to the physician regarding the mechanism of injury, the type of fracture present, and associated soft tissue injuries. A comprehensive detail of system for describing fractures using orthopaedic terminology is described below.

A. Anatomic Location: The name of the bone and the location within the bone is first described. Long bones are typically divided into thirds, with a fracture being in the proximal, middle, or distal third. If a fracture is through a specific anatomic part of a bone, that term is preferred (e.g., a fracture through the neck of the femur).

B. Fracture Line or Pattern: The fracture line is its direction through the bone relative to the bone’s long axis.

1. Transverse: The fracture line is perpendicular to the long axis of the bone. This injury is usually due to direct trauma and is typically stable.
2. Oblique: The fracture line runs at an oblique angle to the long axis of the bone. This injury results from indirect trauma and is normally associated with less soft tissue damage and faster healing than a transverse fracture.
3. Spiral: The fracture line curves in a spiral fashion around the bone. It is caused by a torsional or rotational force.
4. Comminuted: Fracture in which more than two fragments are present are termed comminuted. Such fractures are often associated with significant soft tissue injury and are unstable.
   • Butterfly: This is a type of comminuted fracture with a characteristic butterfly-shaped fragment.
   • Segmental: The bone is fractured at two distinct levels. Reduction of this fracture is difficult and nonunion common.
5. Impacted: This is a fracture in which the ends are driven into each other. Cancellous bone is typically involved, and union often occurs rapidly. A torus fracture is a pediatric impaction fracture in which the cortex of a long bone buckles, with no loss of cortical continuity.
6. Compression: This occurs in cancellous bone, when an excessive axial load compresses the bone beyond its limits. It typically occurs in the verterbal bodies.
7. Depressed: This is a fracture of the cortical bone caused by a localized force that breaks and depresses one segment below the level of surrounding bone.

C. Displacement: Bone fragments that have shifted relative to each other are displaced. In describing the deformity, the position of the distal fragment is noted relative to the proximal one. The degree of shifting should be estimated by determining the percentage of fracture surfaces in contact.

1. Bayonette Deformity: The fracture fragments are 100% displaced, shortened, and overlapping.
2. Distraction Deformity: Fracture fragments are displaced along axis of the bone. Distracted segments with gaps greater than 0.5 cm may require a lengthy healing time.

D. Angulation: The angle between the longitudinal axes of the main fracture fragments must be measured. Fractures that demonstrate significant angulation must be reduced or function will be compromised. In weight-bearing areas, abnormal stress to joints due to angulation may lead to osteoarthritis.

Angulation is described in several ways:

1. The relationship of the bone distal to the fracture site with respect to the proximal is described e.g., a Colles fracture is a distal radial fracture with dorsal angulation of the distal fragment.
2. The terms ulnar, radial, volar, and dorsal are used if the fracture is in the forearm and hand. In the foot, plantar and dorsal are used. An alternative description is the direction in which the apex of the fracture fragments points e.g., a Colles’ fracture is a distal radial fracture with the apex angled volarly.
3. Valgus and varus describe the angular relationship of the distal part to the proximal part around a known axis. Valgus means that the distal part is angled laterally relative to the proximal part, and varus means that the distal part is angled medially.

E. Axial Rotation: Fragments that are rotated with respect to each other must be recognized. To comment on rotation, radiographs should include the joints above and below the injury. Differences in the measured diameters of the bone fragments can also be used to detect rotation.

F. Additional Terminology:

1. Incomplete/Complete Fractures: A fracture is complete if both cortices of the bone are interrupted and incomplete if only one is involved. A greenstick fracture is an incomplete fracture in children in which the cortex and periosteum are broken on one side only. It occurs in young bones that are porous, less brittle, and more apt to bend than to break completely.
2. Stable/Unstable Fracture: Unstable fracture are those that tend to displace after reduction, whereas stable fractures remain in place after reduction.
3. Complicated/Uncomplicated Fracture: Complicated fractures are those in which there is significant soft tissue damage to major nearby structures (nerves, vessels, ligaments, and muscles). Uncomplicated fractures involve only minimal soft tissue damage.
4. Extraarticular/Intraarticular Fracture: Intraarticular fractures are those in which the fracture line extends into the joint space. Extraarticular fractures are those in which the fracture line does not enter the joint space.
5. Open (Compound) Fracture and Closed (Simple) Fracture: A closed fracture is one in which the skin overlying the fracture site is intact. An open fracture is one in which the skin over the fracture site is broken. Open fractures may occur when a bone fragment from within breaks out through the skin or when some outside force penetrates both the skin and bone. The latter scenario has a poorer prognosis, as there is often greater soft tissue damage and a greater risk of contamination. Open fractrues are surgical emergencies, and most require operative treatment.

G. Specific Fractures:

1. Stress Fractures: Stress fractures are caused by repetitive loading beyond the tolerance of a bone. Each individual stress causes minute fracture that, over time, develop into a complete fracture. Patients present with pain but without a definite history of trauma. The classic example is the second metatarsal fracture in army recruits called March fracture that occurs when army marches.
2. Pathological Fracture: These occur in bones weakened by preexisting disease. The strength of the bone is compromised and often only minor trauma precipitates a fracture. Osteoporosis, infection, and tumors are common causes of pathological fracture.
3. Avulsion Fractures: Traction on a ligamentous attachment to bone or a forcible muscular contraction that pulls attached bone away causes an avulsion fracture.
4. Fractures By Name : Many fractures are known by the persons who first described them. Though not scientific but it is a common practice to call fractures by these names.

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