A fracture, simply put, is a broken bone. While mild strains and sprains of ligaments and muscles can often be treated at home, fractures typically require professional medical care. You can usually tell that you have a broken bone because the area is much more swollen or painful than it would be with a less severe injury. The injured area may have significant bruising and the pain may be so severe that you cannot use the limb normally—for example, with a broken leg or foot, you won’t be able to walk or put weight on the affected limb.
Sometimes, fractures that are near joints can be associated with a joint dislocation. These types of fractures are more complex and are termed, fracture-dislocations. In a dislocation, the bony components of a joint become disjointed. Consequently, the joint no longer works properly. Typically these types of fractures require surgery.
Types of Bone Fractures
How Fractures are Described
There are a number of different ways to describe fractures which oftentimes determine how the fracture will ultimately be managed:
- Open versus closed. A closed fracture is one in which the skin overlying the fracture is still intact. An open fracture, previously referred to as a compound fracture, is one where there is communication between the environment and the fracture site i.e. the overlying skin is not intact. Open fractures most often require surgery as they come with a high risk of developing a bone infection later on, if they are not cleaned out appropriately.
- Simple versus comminuted. A simple fracture is one where there are only 2 major bone fragments and one fracture line. A comminuted fracture is one where there are multiple bone fragments and multiple fracture lines.
- Complete versus incomplete. In complete fractures, fracture lines go completely across the bone — i.e. through both cortices. Incomplete fractures, which are usually seen in children, have a fracture line that only crosses through part of the bone. Greenstick and torus fractures are both examples of incomplete fractures.
Fractures can also be described based on any underlying deformity (abnormal positioning of the bones). Typically this is accomplished by describing the relationship of the fractured bone fragments to one another (distal fracture fragment is described in relation to the proximal fracture fragment).
- Displacement or Shortening. Fractures can be displaced (i.e. the fractured ends are in different planes or distracted) or shortened.
- Angulation. When the fracture fragments create angles between them, these angles can be characterized based on the size and direction of the angle.
- Rotation. Fractures can also be rotated. One fracture fragment may be rotated in relation to the other. This most often occurs in long bones like the humerus and femur.
The Orientation of the Fracture Line
As described prior, a fracture can be described based on the direction of the fracture line. Fractures lines often give the clinician clues about how the injury occurred. They also assist the clinician in understanding how much force was applied to the bone. Knowing how much force was applied to the bone allows the clinician to predict how much soft tissue damage there may be around the fracture. All this information helps when determining the best treatment plan for the management of the fracture.
Transverse: the fracture line is perpendicular to the long axis of the bone. This typically is caused by a direct blow to the bone. e.g. car hits tibia (shin bone).
Spiral: the fracture line is in the shape of a spiral. This typically occurs as a result of a rotational injury.
Compression: an axial force along the bone can produce a compression fracture, particularly in osteoporotic (or weakened) bone.
Oblique: the fracture line is diagonal in direction. Occurs in a similar manner to transverse fractures.
Avulsion: an avulsion fracture results from a ligament or tendon pulling a fragment of bone away from the main bone mass.
Comminuted: a comminuted fracture is typically the result of a high energy injury. However, in very brittle bone, e.g. osteoporotic bone, it may not take much energy to cause comminution.
Common Fractures and their Eponyms
Fracture of the distal radius with dorsal angulation.
Fracture of the distal radius with palmar angulation resulting from a fall on a flexed hand
Fracture at the base of the 5th metatarsal
Fracture of the neck of the 5th metacarpal with palmar angulation which most often results from punching a person or a wall
Fractures need to be immobilized in order for them to heal. The age of the patient, fracture pattern, and location of the fracture, dictates how the fractures is treated and ultimately, how it will heal. The treatment of each individual fracture is complex and beyond the scope of this article.
Fracture healing occurs through multiple stages which are listed below. Ultimately, fractures take about 10-12 weeks to fully heal. In kids, this often occurs much more quickly. In older adults, it may take longer.
- Soft callous production
- Bony callous production
- Remodeling of bone
Soft Tissue Injuries From Fractures
Surrounding soft tissues such as blood vessels, nerves, muscles, tendons and ligaments can be injured when a fracture occurs. The amount of soft tissue damage that occurs is related to the type of fracture pattern and the amount of energy involved in the injury.
Injuries to vessels and nerves are uncommon but may have serious implications. Addressing these injuries in a timely manner may be very important in optimizing your treatment outcome, so it’s important to see a clinician as soon as possible if you suspect that you may have fractured a bone.