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
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.
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.
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.
If the injury results in multiple breaks in the bone, they are visible as different fragments. These kind of fractures are called comminuted fractures.
Apart 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
The bone is fractured at two distinct levels. Reduction of this fracture is difficult and nonunion common as seen in following xray
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
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
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.
Unstable fracture are those that tend to displace after reduction, whereas stable fractures remain in place after reduction.
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.
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.
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.
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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