• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Home
  • About
  • Newsletter/Updates
  • Contact Us
  • Policies

Bone and Spine

Orthopedic health, conditions and treatment

  • General Ortho
  • Procedures
  • Spine
  • Upper Limb
  • Lower Limb
  • Pain
  • Trauma
  • Tumors

Different Types of Fractures

By Dr Arun Pal Singh

In this article
    • Types of Fractures based on Breaking Pattern
      • Transverse Fracture
      • Oblique Fracture
      • Spiral Fracture
      • Comminuted Fracture
      • Segmental Fracture
      • Impacted Fracture
      • Compression Fracture
      • Depressed Fracture
    • Types of Breaks Based on Displacement of Fragments
    • Incomplete and Complete Fractures
      • Incomplete Fractures
      • Complete Fractures
    • Stable and Unstable Fractures
      • Unstable Fractures
      • Stable Fractures
    • Based on Soft Tissue Damage
      • Complicated Fracture
      • Uncomplicated Fractures
    • Types of Fractures based on Articular Involvement
    • Presence of Wounds that Communicate with a Fracture
    • Fractures Caused by Insufficient Trauma
    • Eponymous Fractures
      • Related

Fractures occur when bones break due to energy applied to them in excess of what these can sustain. There could be different types of fractures depending on the site and severity of the injury, type of force that acted on bone and involvement of surrounding tissues.

There are multiple ways to list the types of fractures. 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 and often more than one 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 Fractures based on Breaking Pattern

Different types of fractures which are based on breaking pattern are

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 an 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

The 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 into two, it is similar to the oblique fracture. But if you twist and break that stick it would result in a broken pattern that would start from one point, move obliquely in one direction, reach the other end and then continue on 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. The reduction of this fracture is difficult and nonunion common as seen in the 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 the 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 the surrounding bone. These are generally intra-articular fractures and are commonly seen in the knee.

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

Types of Breaks 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 fragments of the bone may move from their original position resulting in 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

Incomplete and Complete Fractures

These terms indicate the completeness of a 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.

Stable and Unstable Fractures

Unstable Fractures

Rather than the initial displacement, unstable fractures are those fractures that tend to displace after reduction. This stability after reduction is important as it guides 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 minimal soft tissue damage.

Here, I must mention that 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 that 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 not closed any more but is open to the external environment.

In some injuries like pelvic injuries, if an internal visceral wound 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 Fractures]

Fractures Caused by Insufficient Trauma

Most of the fractures are caused by significant trauma. However, there are types of fractures 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 the 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 that 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 of Proximal Femur. Pathological fractures are types of fractured in already diseased bone
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 a long distance without training.

A point to note is that bone is otherwise normal in these cases i.e. not weakened by any pathology.

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

Related

Spread the Knowledge
7
Shares
 
7
Shares
 7   

Filed Under: Trauma

About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

Primary Sidebar

Browse Articles

Cerebral palsy in child

Cerebral Palsy Presentation and Management

Cerebral palsy is a group of permanent movement disorders appearing in early childhood and caused by abnormal development or damage to the parts of the brain that control movement, balance, and posture. The symptoms often include poor coordination, stiff muscles, weak muscles, and tremors. There could also be problems with sensation, vision, hearing, swallowing, and […]

bone stimulators

Bone Stimulators – How Effective are They?

Bone stimulators or bone growth stimulators are devices which are used for enhancing the union of bone. Nonunion [failure of the fracture to unite] or delayed union [fracture unites slower than expected] are common and significant problems in the bone union. Internal or external fixation, bone grafting, and more radically and rarely amputation are the […]

Do backpacks cause back pain children

Backpacks and Back Pain- Tips to Use Backpacks in Children?

Back pain in children is not that common and often may be associated with underlying disorders. However, recent evidence has suggested backpacks in school-going children to be a cause of back pain. Yes! backpacks and back pain could be related. The school going does involve carrying backpacks filled with books and materials and is continuing […]

Orthopedics Operating room

Principles of Treatment of Fractures

It is a dictum in orthopedics that no two fractures are alike. Every fracture behaves differently from other. In the same part fractured, there could be different types of treatment depending on many factors other than fracture geometry. Treatment of fractures takes various things into consideration -age of the patient, fracture pattern, type of bone […]

Ottawa ankle rules

Ottawa Ankle Rules for Ankle Injury Radiography

Ankle injuries are very common injuries and not all ankle injuries require x-ray evaluation. Ottawa ankle rules for ankle injury radiography is an attempt to answer when the x-rays should be done in cases of ankle injuries. Because the rule is sensitive and not specific, it provides a clear guide of which patients not to […]

Radiolunate Angle

Wrist Instability Types, Diagnosis and Treatment

Wrist Instability or carpal instability occurs when takes wrist is damaged by trauma, chronic inflammation or anatomical alterations like ulnar variance and neoplasms. Injuries to the ligaments of the wrist represent a broad spectrum of pathology. There are a number of ligaments of the wrist maintaining a complex articulation of carpal bones. Ligament injuries are […]

Flexion Type Teardrop Fracture of Cervical Spine

Lower Cervical Spine Injury or Injury to C3-C7 vertebrae

The term lower cervical spine injury refers to the Injury of the subaxial cervical spine or that is below axis. It includes injuries to C3-C7 vertebra and adjoining structures. Lower cervical spine injuries are very common and are associated with substantial mortality and morbidity. The cervical spine can get injured during motor vehicle accidents or […]

© Copyright: BoneAndSpine.com
Manage Cookie Consent
The site uses cookies. Please accept cookies for a better visiting experience.
Functional Always active
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
Preferences
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
Statistics
The technical storage or access that is used exclusively for statistical purposes. The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
Marketing
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.
Manage options Manage services Manage vendors Read more about these purposes
View preferences
{title} {title} {title}
 

Loading Comments...