Fracture or a Break


It is quite common to ask a patient who has injured a bone “so you have had a break?’ To be told no I have had a fracture.  The terms are synonymous.

A fracture of a bone is in essence a discontinuity of the bone and it may vary from a simple crack in the bone to a substantial injury.

When describing a fracture it is necessary to look at a number of points. It is best to think that you are describing the fracture to someone over the phone so that the other person is developing a mental image based on your description.

Open or closed

This refers to whether the skin overlying the fracture is broken and allows the fracture to communicate with the open. The importance of this is related to the potential risk of infection. Open fractures have a much higher risk of infection and they need to be managed urgently with an initial washout of the wound. Open fractures also imply a greater degree of energy that may have been imparted to the limb.

Compound fracture illustrating skin has opened over the fracture site

Compound fracture illustrating skin has opened over the fracture site

 

Which bone is fractured

Clearly this is important as it tells us what part of the body has been injured.

Location of the fracture

This is simple and can be broken into fractures in the proximal, middle or distal third of the length of the bone

Proximal humeral fracture

Proximal humeral fracture

 

Mid shaft humeral

Mid shaft humeral

 

Intra-articular/extra-articular

This refers to weather the fracture extends into the joint surface or not. The importance of intra-articular fractures is that they have an associated risk of arthritis and it is important to maintain the congruency of the articular surface. It is important to avoid even a 1 mm step as the risk of arthritis increases in the future if there is an incongruent surface.

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Comminution

This refers to the number of pieces there are in the bone. Where there is more then the two ends of the fracture the injury is said to be comminuted i.e. there is 3 or 4 or even more pieces of bone. The more comminuted the fracture the more complex the injury and it is also implies a higher energy level.

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Transverse/oblique/spiral

This is the description of the shape of the fracture line. This is very important as it helps to determine the forces that were applied to the bone. Spiral fractures for e.g. occur due to a twisting action. These are important to pick up in children, as it may imply no accidental injuries.

Transverse fracture

Transverse fracture

 

Oblique fracture

Oblique fracture

 

Spiral fracture

Spiral fracture

 

Displacement

This refers to the movement between the two bone ends. If the two ends of the bone have not shifted apart then it is an undisplaced fracture. Displacement may vary from slight to the bone no longer being in contact any more i.e. completely displaced.

Displaced fractures often need surgery or a manipulation to improve the position

Transverse fracture of the mid shaft of the radius that is completely displaced (off-ended)

Transverse fracture of the mid shaft of the radius that is completely displaced (off-ended)

 

Angulation

This refers to whether the alignment of the bone has sifted to produce an angle at the site of the fracture. It is important to look at the change in angulation in at least two views

Fracture of the radius with angulation(angle exists between the two sides of the fracture)

Fracture of the radius with angulation(angle exists between the two sides of the fracture)

 

I hope this simple explanation is helpful.