Types of fractures and their pattern vary according to the site of the injury, the severity of injury and involvement of surrounding tissues.
There are multiple ways to list the types of fracture, and it is important to do so.
The classification of fractures not only helps to suggest the severity and mechanics of injury that occurred but also helps to formulate the most suitable treatment.
There are many types of fracture classifications which are available to physicians. These classifications vary with the type of bone involved and the region of bone involved. There is sometimes more than one classification available for a given region of fracture.
In this article, we would stick to the basic definition of fracture and general classification of fractures that could be applied across all the regions.
Types of Fractured based on Breaking Pattern
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. The following figure would illustrate.
In this fracture, instead of the break being at the 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 the 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 another side of the stick in a spiral fashion to meet the original point.
The diagram above would give you a 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 kinds of fractures are called comminuted fractures.
It is a type of comminuted fracture only.
The bone is fractured at two distinct levels. Reduction of this fracture is difficult and nonunion common as seen in following x-ray. Segmental fracture is defined as a comminuted fracture where one fragment retains the complete cortex of the bone.
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 or buckle fracture is a pediatric impaction fracture in which the cortex of long bone buckles, with no loss of cortices.
This is a fracture of the cancellous bone caused by a localized force that breaks and depresses one segment below the level of surrounding bone. These are generally intra-articular fractures and commonly seen in the knee.
Fracture Type based on Displacement of Fragments
Depending on the displacement of fragments, the 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 the fragment of the bone may move from their original position resulting separation of the fragments. Such a fracture is called a displaced fracture.
Butterfly fragment is a popular term for a wedge-shaped fragment of the bone split from the main fragments,
The following x-ray would show a butterfly fragment
Types of Fractures indicating Completeness of Fracture
An incomplete fracture is one where the fracture has not involved the bony cortex on all sides. torus fractures and greenstick fractures are examples of incomplete fractures.
Incomplete fractures are often seen in pediatric injuries.
A fracture is complete if there is a complete break of cortex on all sides. Depending on the severity of the injury, the fracture may or may not be displaced.
Based on Stability
Rather than the initial displacement, unstable fractures are those fractures which tend to displace after reduction. This stability after reduction is important as it guides to the treatment that should be given and the implant that must be chosen.
These fractures do not tend to displace after the reduction of the fracture.
Based on Soft Tissue Damage
Complicated fractures are those in which there is significant soft tissue damage to major nearby structures (nerves, vessels, ligaments, and muscles).
There is a minimal soft tissue damage.
Here, I must mention this that the there is always an amount of trauma to the surrounding soft tissue whenever a fracture occurs. The bone cannot break in isolation. The energy is dissipated to the soft tissue as well.
But the fracture becomes complicated only when there is significant trauma to the soft tissue that may alter the course of the treatment or prognosis of the injury.
Types of Fractures based on Articular Involvement
These terms are typically used for fractures which occur near the joints.
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.
Presence of wounds that communicate with a fracture.
A fracture that communicates with the external wound is called an open fracture. The fracture thus is closed no more but is open with the external environment.
In some injuries like pelvic injuries, if an internal visceral would is present that communicates with the fracture, the fracture is also an open fracture [open from within].
A closed fracture is one in which the skin or other soft tissue envelope overlying the fracture site is intact.
Examples of open fractures are – When a bone fragment from within breaks out through the skin or when some outside force penetrates both the skin and bone.
Open fractures are surgical emergencies, and most require operative treatment.
[Read more on Open and Closed Fractures]
Fractures Caused by Insufficient Trauma
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 for this.
Fractures resulting from trivial trauma because the bone is weak, are called insufficient fractures.
Osteoporosis, an age-related loss of bone mineral and microarchitectural change in bone. As bone weakens, a trivial trauma can result in fractures. A simple fall in old age may result in fractures of the hip region whereas the same injury in young persons will just result in soft tissue injury.
Such fractures which occur in the osteoporotic skeleton are popularly also called osteoporotic fractures.
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 the disease is quite advanced.
Stress fractures are a special type of fractures which occur with repetitive 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 note is that bone is otherwise normal in these cases i.e. not a weakened by any pathology.
Fractures By Name or Eponymous Fractures
Fractures are also known by the persons who first described them. These fractures are called eponymous fractures. Though not scientific but it is a common practice to call fractures by these names.
There is a long list of eponymous fractures and these have been discussed in a separate article. Few commonly used fracture eponyms are –
- Barton fracture: Intra-articular distal end radius fracture
- Cotton fracture: Trimalleolar fracture of ankle
- Pott’s fracture: Bimalleolar fracture of ankle
- Jones fracture: Fracture of base of the fifth metatarsal
- Monteggia fracture: Ulna fracture with radial head dislocation
- Galeazzi fracture: radius fracture with lower radioulnar joint disruption
You can read more about eponymous fractures
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