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Types of Fractures Based on Different Classifications

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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

Transverse Fracture

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.

transverse fracture illustration

 

Oblique Fracture

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.

oblique fracture illustration

Following x-ray shows an oblique fracture

Oblique Fracture of Femur
Oblique Fracture of Shaft Of Femur

 

Spiral 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 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.

an illustration of spiral fracture

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.

Comminuted Fracture

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

an illustration of comminuted fracture

Segmental Fracture

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.

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 or buckle fracture is a pediatric impaction fracture in which the cortex of long bone buckles, with no loss of cortices.

Compression Fracture

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

Depressed Fracture

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.

Depressed Fracture of Lateral Condyle of TIbia
Depressed Fracture of Lateral Condyle of Tibia

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.

Comminuted Undisplaced Fracture Tibia
A comminuted, undisplaced, spiral fracture Tibia

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.

UNDISPLACED FRACTURE ULNA
Undisplaced fracture of shaft of radius and ulna.

 

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

Butterfly fragment in fracture radius
Butterfly fragment in fracture radius

Types of Fractures indicating Completeness of Fracture

Incomplete Fractures

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.

Complete Fractures

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

Unstable Fractures

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.

Stable Fractures

These fractures do not tend to displace after the reduction of the fracture.

Based on Soft Tissue Damage

Complicated Fracture

Complicated fractures are those in which there is significant soft tissue damage to major nearby structures (nerves, vessels, ligaments, and muscles).

Uncomplicated Fractures

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 a bone is weakened by a disease such as infection, malignancy or lack of nutrition. Spontaneous fractures occur when the 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.

Pathological Fracture Proximal Femur
Pathological Fracture Proximal Femur

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 –

You can read more about eponymous fractures

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Reader Interactions

Comments

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

  10. @Roberto_K_:D,

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

  11. 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?

  13. igot the information thanx to u but iwanted to know how to give 1st aid by just usin a cloth

  15. @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.

  17. 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

  18. @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.

  21. 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

  22. @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.

  25. 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

  26. @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.

  28. 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.

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

  30. @Tara,

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

  31. @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.

  32. 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

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

  35. 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…..

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

    @Dr Arun Pal Singh

  39. many thanks for the classifications extremely helpful, im trainee ENP and i will be forwarding your page onto my peers

  41. hi Dr ARUN i need your valuable advice i m from pakistan i went through a major surgery 6 weeks age i eas involved in a motor bike accident and my left leg had a fracture my leg bone was broken several places so surgeon put plates with screws around broken bone after that i went to the doctor for follow up quiet some time i can;t still put wait on my injured leg i use walker to go to washroom but i sm still going through a tremendous pain all the time specially at night i can’t even sleep because of pain my according to my surgeon i should not experience any pain now but i m going through a lot of pain dr prescribed anly medicine whic is ” NEWGAB a tab of 300 mg at night but it does not help doctor refused to give me strong pain killer or sleeping pills please guide me how long i will experience this pain and will be able tu put wait on my leg and be able to walk without walker one more thing at nifgt when i feel lot of pain my leg where it was operated felt like very hot thanks i m waitng for your kind reply as soon as possible my email address [edited] thanks so much

  42. Tausif,

    After the bone is fixed, it should not cause distressing pain. You have not mentioned the fractured bone and type of surgery. Could you please send an xray to contact [at] boneandspine [dot] com and as a reminder leave a comment here. How are you now, otherwise?

  43. I had a head-on car crash at 65 MPH and in trying to stop (no way) I sustained communities, compound fractures of my right tib/fib, closed, which required ORIF and healed nicely. I also sustained trimalleolar fractures on the right which was pinned in surgery. While the fractures were closed, I did have a fracture blister at the site, filled with brownish fluid. My orthopod explained it was abnormal fluid which needed to find a way out, so the blister formed and it later spontaneously popped and did leave a scar. Thought it was interesting. Thank you for your great info.

  44. Melodee,

    Thanks for sharing your experience. Yes! In case of closed fractures, sometimes the fluid collection raises internal pressure of the closed space. This leads to swelling and sometimes blisters. One of the theories for the blisters formation is what your orthopod suggested. The body attempts to reduced internal pressure by that.

    Keep well and take care.

  45. Oh is so good . It’s like a miracle in my life . Cause only few days are remaining for my school project . My teacher said that it is so better than all projects in my class . He gives +A to my project . Thanks sir for do that work . And there is a recommendation for you , that please add some photographs in it . Thank you .

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