Type of fracture
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Here is a complete, well-organized overview of the types of fractures, drawn from multiple authoritative surgery and emergency medicine textbooks.
Types of Fractures
Fractures are classified across several dimensions: the skin integrity, the fracture line pattern, the displacement, the cause, and the patient's age/bone maturity.
1. Based on Skin/Environment
| Type | Description |
|---|---|
| Closed (Simple) | Skin and soft tissue over the fracture site are intact |
| Open (Compound) | Fracture communicates with the outside environment (bone may or may not pierce the skin) |
When in doubt, always assume open and treat as such. - ROSEN's Emergency Medicine
2. Based on Fracture Line Pattern
These are the most tested and clinically described types:
| Pattern | Mechanism | Description |
|---|---|---|
| Transverse | Direct tapping force / bending | Fracture line at right angles to the long axis of the bone |
| Oblique | Bending / angulation | Fracture line runs at an angle to the long axis |
| Spiral | Rotational/twisting (torsion) | Encircles the shaft in a spiral; important in child abuse evaluation |
| Comminuted | High-energy crushing force | More than two fragments; significant soft tissue injury common |
| Segmental | High energy | Two separate fracture lines isolate a "floating" segment of bone |
| Butterfly | Bending + compression | A separate wedge-shaped fragment at the fracture site |
3. Based on Completeness
| Type | Description |
|---|---|
| Complete | Both cortices of the bone are interrupted |
| Incomplete | One cortex remains intact |
4. Based on Displacement
Displacement is described by the position of the distal fragment relative to the proximal. The mnemonic STAR is used:
- Shortening
- Translation (sideways shift)
- Angulation (varus/valgus)
- Rotation
5. Based on Cause / Special Types
| Type | Key Feature |
|---|---|
| Pathological | Fracture through diseased bone (e.g., osteoporosis, Paget's, metastatic carcinoma). Even trivial force can cause it |
| Stress (March) fracture | No single severe injury; result of repeated mechanical loading (e.g., 2nd metatarsal in soldiers) |
| Avulsion | Bone fragment pulled off by forceful muscle contraction or ligament/tendon resistance |
| Impaction | One fragment is forcefully driven into another (common in proximal humerus, tibial plateau, vertebrae) |
| Compression | Cancellous bone collapses (e.g., vertebral wedge fracture) |
| Depression | Depressed fragment driven inward (e.g., skull, tibial plateau) |
6. Fractures Specific to Children
Children's bones are less dense, more plastic, and have open physes (growth plates), giving rise to unique fracture patterns:
| Type | Description |
|---|---|
| Greenstick | Incomplete cortical disruption with plastic deformation; one tension cortex fails |
| Torus / Buckle | Axial compressive force causes the cortex to buckle without breaking through |
| Plastic deformation | Bone bends without a visible fracture line (commonly the ulna) |
| Physeal (Salter-Harris) | Involves the growth plate; classified I-V based on extent |
7. Based on Fracture Location on the Bone
| Region | Description |
|---|---|
| Diaphysis | Shaft (thick cortical bone) |
| Metaphysis | Flared zone between shaft and joint (thin outer cortex) |
| Epiphysis | End of bone forming the joint surface |
| Intra-articular | Extends into the joint; requires anatomic restoration to prevent post-traumatic arthritis |
| Supracondylar | Just proximal to the epicondyles (e.g., distal humerus in children) |
Summary of Mechanism → Fracture Type
| Violence | Type of Fracture |
|---|---|
| Direct tapping | Transverse |
| Direct crushing | Comminuted |
| Twisting (indirect) | Spiral |
| Bending (indirect) | Transverse or oblique |
| Bending + axial compression | Double oblique / butterfly fragment |
| Muscular pull | Avulsion (patella, olecranon, lesser trochanter) |
| Repeated stress | Stress/march fracture |
Sources: ROSEN's Emergency Medicine, Bailey & Love's Short Practice of Surgery 28th Ed, Sabiston Textbook of Surgery, S Das Manual on Clinical Surgery 13th Ed, Forensic Anthropology 2nd Ed
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