Different types of Fractures – A Simple Classification of Fractures

Types of fractures and their pattern vary according to the site of the injury. For a physician classification of fractures is of utmost importance. Not only it suggests the severity and mechanics of injury that occurred, but also helps to formulate most suitable treatment.There are many types of classifications which are available to physicians. These classifications vary with type of bone involved and the region of bone involved.

For this discussion we would stick to the basic and general classification of the fractures of long bones. We have already discussed closed and open fractures. That is one type of classification according to absence or presence of wounds that communicate with fracture.

Fractures are also classified according to the pattern in which bone breaks. Let us take them one by one

fracture_transverse1.jpgTransverse Fracture

A fracture in which the break is across the bone, at a right angle to the long axis of the bone. Adjoining figure would illustrate.

fractur_oblique1.jpeOblique Fracture

Instead of break being at right angle, it goes in oblique direction to the long axis of the bone.The fracture is confined to one plane. In other words the bone has broken at an angle.

fractur_spiral.jpeSpiral Fracture

This fracture is easily confused with the oblique fracture. Instead of a straight break as in oblique fracture that is only in one plane, the break in this case traverses both the planes. To understand this you need to imagine a three dimensional view of the bone.

If you take a stick and slice it at an angle so that it is divided in two, it is similar to oblique fracture. But if you twist and break that stick it would result in a break pattern that would start from one point, move obliquely in on direction, reach the other end and then continue in other side of the stick in a spiral fashion to meet the original point.

Adjoining diagram would give you rough idea of what I am trying to say. Compare it with the oblique fracture diagram and you would be able to appreciate the difference.

fracture_communited.gifComminuted Fracture

If the injury results in multiple breaks in the bone, they are visible as different fragments. These kind of fractures are called comminuted fractures.

fracture_displaced.gifApart from this, fracture can be displaced or undisplaced. If bone fragments stay together maintaining structural alignment of the bone , it is called an undisplaced fracture. A hairline fracture is an example of an undisplaced fracture.

But fragment of the bone may move from their original position resulting separation of the fragments. Such a fracture is called a displaced fracture. (See the figure)

Butterfly fragment is a  popular term for a wedge-shaped fragment of bone split from the main fragments,

Following xray would show a butterfly fragment

Butterfly fragment in fracture radius

Butterfly fragment in fracture radius

Segmental

The bone is fractured at two distinct levels. Reduction of this fracture is difficult and nonunion common as seen in following xray

Segmental Fracture Fibula with Fracture Tibia

Segmental Fracture Fibula with Fracture Tibia

 

Impacted Fracture

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 corti

Compression Fracture

This occurs in cancellous bone, when an excessive axial load compresses the bone beyond its limits. It typically occurs in the verterbal bodies.L3-compression-fracture

Depressed Fracture

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.

Additional Terms in Fractures

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.

Stable/Unstable Fracture

Unstable fracture are those that tend to displace after reduction, whereas stable fractures remain in place after reduction.

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.

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.

Open  and Closed  Fractures

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.

Other Types of Fractures

Most of the fractures are caused by significant trauma. However there are types of fractures are caused by insignificant trauma. There may be several reasons to this.

Fractures resulting from trivial trauma because bone is weak, are called insufficient fractures.

Osteoporosisis an age related loss of bone mineral and microarchitectural change in bone. As bone weakness a trivial trauma can result in fractures. A simple fall in old age may result in fractures of hip region whereas same injury in young persons will just result in soft tissue injury.

Pathological fractures occur when bone is weakened by a disease such as infection, malignancy or lack of nutrition. Spontaneous fractures occur when bone is so weakened that fracture may occur even by forces of daily use e.g., lifting of hand or simple movements of walking. This generally occurs when disease is quite advanced.

Stress fractures are special type of fractures which occur with repetitive of exposure of the normal bone to the forces to which it is not accustomed to. An example of this would be sudden jogging for long distances without training. A point to not is that bone is otherwise normal in these cases i.e. not a weakened by any pathology.

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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Comments

  1. Roberto_K_:D says

    Hey Dr Arun, thanx. This has really helped me in case i break a bone, thanks a lot, much appreciated :D

  2. Dr Arun Pal Singh says

    @Roberto_K_:D,

    You are welcome.
    It is not a good idea to think like that. may that never happen.
    :-)

  3. adam says

    i recently fractured the side of my hip as a muscle tore and ripped of a piece of bone, i think the nurse told me it was an expulsion fracture but im not sure as i was out of my head on medication and happy gas. is expulsion fracture correct?

  4. Dr Arun Pal Singh says

    @som,

    In upper limb cloth can be used as sling or to stra arm to the torso.

    In lower limb the cloth can be used to tie the injured limb to other limb for splintage.

    I hope that helps.

  5. aashisha says

    this website and the imformation has realy helped me a lot for my project

    THANK YOU

  6. Melina says

    I am 58 years and broke mi humerous 7 months ago. It was an spiroid fracture, a few cm. from the shoulder, at the armpit level. An operation was not possible due to a chronic respiratory deficiency that makes it impossible to receive any kind of anesthesia (local or general). I was put on an “U” cast for 2 months and then doctors took it out for they said union had taken place between the two parts of bone. After some days problems started: I felt the 2 pieces of bone moving, and xray showed they were separated, in what doctors call pseudoarthrosis. Now they are going to put my arm on a brace, but I don’t know how the process will be. Thak you in advance for any comment or advice

  7. Dr Arun Pal Singh says

    @Melina,

    From what you have told, it means that you have a non union.
    Non unions are generally refractory to conservative measures.
    But given your condition of respiratory deficiency, I am not sure if you have much options.
    Talk to your doctor.

  8. Melina says

    Having established the non union of the humerous bone fragment doctors put a brace bivalve and recommended Magnetic therapy sessions. I would like to know your oppinion.

    thank you

    Melina

  9. Dr Arun Pal Singh says

    @Melina,

    The standard treatment for non union is bone grafting. Nothing else matches the results of this surgery. But each individual is different. I cannot say why have you been chosen for the particular treatment.

  10. Prince says

    Strongly recommend the website to student nurses and other health proffessions. was the best, the most outstanding of them all.

    if i may ask, a have this assignment question which says, why is it generally important to classify fractures (3 marks) but i managed only to pick one from the website. please help me with two more

  11. Dr Arun Pal Singh says

    @Prince,

    1. Enables better communication to describe the type of injury
    2. Helps to understand biomeachanics of injury
    3. Enables to formulate treatment
    4. Tells prognosis

    All the points may not be covered by a single classification.

  12. Dallas Ink says

    I'm not sure I understood the doctor correctly: Elderly patient with fibular fracture, nondisplaced, cleared by physical therapy so "there was no evidence clinically of a s/l myxino fracture." Is there such a fracture?

    Thanks so much! I, too, have recommended your site as reference for medical transcriptionists. VERY organized and easy to understand.

  13. Tara says

    Thanks this was nice and handy! I don't mean ti be rude or anything but isnt there a chip fracture also?

  14. Dr Arun Pal Singh says

    @Tara,

    Thanks! Yes there is but it is a classification of fractures of long bones. Chip fractures usually occur near joints.

  15. Dr Arun Pal Singh says

    @Dallas Ink,

    Maisonneuve fracture is a similar sounding fracture. Jump to: navigation, search
    Malleolus
    Fibula

    The Maisonneuve fracture is a spiral fracture of the proximal third of the fibula with a tear of the distal tibiofibular syndesmosis.

    Otherwise, there is no fracture with same name as you mentioned.

    Thanks for your kind encouragement.

  16. Gime Evrifin TONAIT says

    This website is really helpful, clear and effective. You might as well recommend on facebook , twitter etc.. I personally think this is the most outsanding, easy to understand and well explained website on this I have seen.

    Gime

  17. Badkiodrokitinoro says

    This is really helpful, i can just copy paste this for my homework :D thnx

  18. Sreshta says

    This was simply amazing.I was in a hurry to complete my homework.at that movement this helped me a lot.I thank all the writers of this page which gives an extraordinary information,which was short and sweet…..

  19. art says

    who is most likely to suffer from each fracture (adolescent, adult, male , female ) and why?

    @Dr Arun Pal Singh

Trackbacks

  1. [...] Oblique fractures result due to indirect trauma on the bone.Femoral fractures require a major trauma to occur. [...]

  2. [...] Oblique fractures are the fracture at an angle to transverse axis of the bone and extend into two planes. Oblique fractures are result of an indirect trauma. [...]

  3. [...] Cmminuted fractures are generally as a result of direct trauma to the bone. Following xray is anteroposterior view of the forearm and is revealing fracture ulna. A comminuted fragment is seen in the ulnar fracture. Comminuted Fracture of Ulna [...]