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Bone and Spine

Orthopedic health, conditions and treatment

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

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

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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

Reader Interactions

Comments

  1. rio says

    November 18, 2008 at 12:25 pm

    this was a really helpful website for my homework. It was nice and simple which was handy because i was in a rush!

  2. Dr Arun Pal Singh says

    November 20, 2008 at 8:44 am

    Thanks Rio for your appreciation.

  3. lroy says

    February 2, 2009 at 1:05 am

    thought id right to show my appreciation, agreed with rio, really helpful, thanks!

  4. Dr Arun Pal Singh says

    February 2, 2009 at 7:38 am

    Thanks Iroy.

  5. priyanshi says

    September 14, 2009 at 10:00 pm

    thank u u made my work easier

  6. Dr Arun Pal Singh says

    September 15, 2009 at 8:20 pm

    @priyanshi,

    You are welcome.

  7. Amal says

    September 26, 2009 at 2:08 pm

    Tanx alot Dr. it was very helpful indeed, and wat about open fracture?

  8. Dr Arun Pal Singh says

    October 1, 2009 at 7:49 am

    @Amal,

    Thanks for your appreciation.
    You might want to have a look at following article https://boneandspine.com/fractures-dislocations/op…

  9. Roberto_K_:D says

    October 9, 2009 at 1:04 am

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

  10. Dr Arun Pal Singh says

    October 9, 2009 at 7:10 pm

    @Roberto_K_:D,

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

  11. adam says

    November 2, 2009 at 10:37 pm

    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?

  12. Dr Arun Pal Singh says

    November 3, 2009 at 7:37 am

    It is called avulsion fracture.

  13. som says

    March 3, 2010 at 3:59 am

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

  14. som says

    March 3, 2010 at 4:02 am

    can u reply fast

  15. Dr Arun Pal Singh says

    March 3, 2010 at 6:22 am

    @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.

  16. aashisha says

    April 28, 2010 at 5:15 pm

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

    THANK YOU

  17. Melina says

    September 29, 2010 at 9:02 am

    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. Dr Arun Pal Singh says

    October 3, 2010 at 9:52 pm

    @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.

  19. Melina says

    October 12, 2010 at 1:22 pm

    Thanks you for your oppinion.

    Melina

  20. Dr Arun Pal Singh says

    October 15, 2010 at 9:17 pm

    @Melina,

    Welcome!

  21. Melina says

    November 6, 2010 at 10:01 am

    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. Dr Arun Pal Singh says

    November 8, 2010 at 4:57 am

    @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.

  23. Stanley Eric says

    March 7, 2012 at 10:17 pm

    knowledge is power

  24. sandile says

    March 10, 2012 at 11:57 pm

    this website really improves ,congratulations.

  25. Prince says

    March 12, 2012 at 8:37 pm

    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. Dr Arun Pal Singh says

    March 14, 2012 at 12:00 pm

    @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.

  27. machiya hamis says

    April 17, 2012 at 9:43 pm

    LIKE THIS

  28. Dallas Ink says

    May 22, 2012 at 9:19 am

    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. Tara says

    May 22, 2012 at 10:07 am

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

  30. Dr Arun Pal Singh says

    June 7, 2012 at 1:49 pm

    @Tara,

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

  31. Dr Arun Pal Singh says

    June 7, 2012 at 2:17 pm

    @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. Gime Evrifin TONAIT says

    June 11, 2012 at 8:55 pm

    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. Badkiodrokitinoro says

    June 12, 2012 at 2:14 am

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

  34. Dr Arun Pal Singh says

    July 1, 2012 at 7:42 pm

    @Badkiodrokitinoro,

    I think you have already done that. :-)

  35. Sreshta says

    September 11, 2012 at 2:39 am

    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. art says

    September 21, 2012 at 2:09 pm

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

    @Dr Arun Pal Singh

  37. dr.hamzah k.s says

    November 9, 2012 at 11:58 am

    it habeen really helpfull because i was confusing spiral and oblique

  38. ruby says

    November 1, 2015 at 3:34 pm

    thank you so much for the info.

  39. trainee ENP says

    February 23, 2016 at 11:12 pm

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

  40. Dr Arun Pal Singh says

    March 5, 2016 at 9:49 am

    Thank you. I am glad you found it useful.

  41. tausif siddiqui says

    March 22, 2016 at 12:26 pm

    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. Dr Arun Pal Singh says

    March 31, 2016 at 8:48 pm

    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. Melodee Roman says

    January 18, 2017 at 1:07 pm

    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. Dr Arun Pal Singh says

    January 25, 2017 at 12:11 pm

    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. Nilesh aher says

    September 16, 2017 at 6:51 pm

    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 .

  46. Larry Weaver says

    July 1, 2019 at 10:36 pm

    I didn’t realize that there is sometimes more than one classification for a given area of a fracture. I believe that my wife is dealing with a vertebral fracture, but until she gets medical help, I am unsure what exactly she is dealing with. We will be sure to find a doctor we can go to so that my wife’s fracture can be checked out.

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