fracture and classification

1. Dr P ROHIT RAJ
MBBS , MS Ortho
Assistant professor
Orthopaedic department
Vishwabharathi medical college

2. Topics to be covered…
1. Fracture
2. Types
3. Displacement
4. Mechanism

3. Fracture
A fracture is a break or disruption
in the continuity of bone or it is a
disruption of the normal architecture
of the bone.

4. Normal Bone and Normal Ossification
Bone Terms
Epiphysis
Epiphyseal Plate (physis)
Metaphysis
Diaphysis
Fracture location
Diaphyseal fracture
Metaphyseal fracture
Physeal fracture

5. • Fracture types
avulsion fracture
complete fracture
transverse fracture
oblique fracture
spiral fracture
longitudinal fracture
comminuted fracture
segmental fracture
incomplete fracture
buckle fracture
green stick fracture
• Displaced vs undisplaced
• Compound fracture
• Pathological fracture
• Stress fracture

6. Avulsion
Avulsion is a fracture of bone
resulting from the strong pulling
effect of tendons or ligaments at
the bone attachment.

7. • Fracture types
avulsion fracture
complete fracture
transverse fracture
oblique fracture
spiral fracture
longitudinal fracture
comminuted fracture
segmental fracture
incomplete fracture
buckle fracture
green stick fracture
• Displaced vs undisplaced
• Compound fracture
• Pathological fracture
• Stress fracture

9. • Transverse fracture
It is a fracture in which the line of the fracture
extends across the bone shaft at a right angle to
the longitudinal axis.

10. • in atransverse fracture the fragments usually remainin place after
reduction

11. Oblique fracture
It is a fracture in which the line
of the fracture extends in an oblique
direction.

12. Tibia Fracture
• Oblique, almost spiral
fracture line
• Barely visible on the
frontal study

13. • Spiral fracture
It is a fracture in which the line of the
fracture extends in a spiral direction
along the shaft of the bone.

14. Spiral Fracture
• Bone is broken by twisting
Spiral fracture of femur

15. Longitudinal fracture
• It is an incomplete fracture in which
the fracture line run along the
longitudinal axis of the bone.
• The periosteum is not torn away from
the bone.

16. Comminuted fracture
It is a fracture with more than
two fragments. The smaller fragments
appear to be floating.

17. Comminuated fracture
• Two or more bone pieces - high energy trauma

18. Complete fractures: (a) transverse; (b) segmentaland
(c) spiral

19. • Fracture types
avulsion fracture
complete fracture
transverse fracture
oblique fracture
spiral fracture
longitudinal fracture
comminuted fracture
segmental fracture
incomplete fracture
buckle fracture
green stick fracture
• Undisplaced vs displaced
• Compound fracture
• Pathological fracture
• Stress fracture

20. Incomplete fractures:
(a) buckle or torus and (b,c))greenstick.
Incomplete fractures:

21. Greenstick fracture
It is an incomplete fracture with
one side splintered and the other
side bent.

22. Greenstick
FRACTURES
 Bending mechanism
 Failure on tension side
 Incomplete fracture,
plastic deformation on
compression side
 May need to complete
fracture to realign

24. BUCKLE OR TORUS FRACTURE
 Compression failure
 Stable
 Usually at
metaphyseal /
diaphyseal junction

25. • Fracture types
avulsion fracture
complete fracture
transverse fracture
oblique fracture
spiral fracture
longitudinal fracture
comminuted fracture
segmental fracture
incomplete fracture
buckle fracture
green stick fracture
• Displaced vs undisplaced
• Compound fracture
• Pathological fracture
• Stress fracture

26. Displaced (overriding)fracture
It involves a displaced fracture
segment that is overriding the
other bone fragment.
The periosteum is disrupted on both
sides.

27. Communication or non communication
with the external environment
• Open fracture
• Closed fracture

28. Pathologic Fracture
• It is a spontaneous fracture at the site of bone
disease.
Causes
Bone tumors, metastatic lesions, infection,
metabolic disease and an injury to old fracture
site.

29. • Stress fracture
It is a fracture that occurs in normal or
abnormal bone that is subject to repeat
stress, such as from jogging or running.
They are considered as overuse
injuries.

30. Stress fracture
• Abnormal stress on normal bone (fatigue fracture) or normal stress
on abnormal bone (insufficiency fracture).

31. Fracture dislocation/subluxation
• Fracture involves a joint: results in malalignment of
joint surfaces.

32. Impacted fracture
It is a comminuted fracture in which
more than one fragments are driven
into each other.

33. Impaction Fracture Radius

34. Crush fractures
• Fracture in cancellous bone: result
of compression (osteoporosis)

35. Intraarticular fracture
It is a fracture extending to the
articular surface of the bone.

36. Howfractures aredisplaced
• Fractures canbe displaced by:
– Forceof the injury
– Effects of gravity
– Pull of muscles attached to thesite

37. Anatomic description - Displacement
 Displacement is the amount the pieces
of a fracture have moved from their
normal location
 Can be displaced or non-displaced
 Subdivided into 3 sub-categories:
translation, angulation, and shortening

38. Displacement - Translation
 Translation is
sideways motion of
the fracture - usually
described as a
percentage of
movement when
compared to the
diameter of the
bone.

39. Displacement - Angulation
 Angulation is the
amount of bend at a
fracture described in
degrees.
Described with
respect to the apex
of the angle or with
respect to direction
of distal fragment.

40. Displacement - Shortening
 Shortening is the
amount a fracture is
collapsed expressed
in centimeters.
Sometimes called
bayonette
apposition.

41. Mechanismofinjury
• Injury
• Repetitive stress
• Pathologicalfractures

42. HIGH-ENERGY
INJURY

43.  High-energy injury

44. LOW ENERGY INJURY

45.  Low-energy injury

46. • INJURY
o Direct force- With adirect force, the bone
breaks at the point of impact; the soft tissues
also are damaged.
o Indirect force -the bone breaks at a
distance from where the force isapplied.

47. Some fracture patterns reveals the
dominant mechanism:
 Spiral pattern- twisting
 Oblique- compression
 Triangular- bending
 Transverse-tension
Mechanism

48. Somefracture patterns suggestthe causalmechanism: (a) spiral pattern (twisting); (b)short
oblique pattern (compression); (c)triangular ‘butterfly’fragment (bending) and (d) transverse pattern
(tension). Spiral and some(long) oblique patterns are usually due to low-energy indirect injuries;bending and
transverse patterns are causedby
high-energy direct trauma.

51. • FATIGUE ORSTRESSFRACTURES-
Occur in normal bone, subject to repeated
heavy loading, typically in athletes, dancersor
military personnel.
Drugslike steroids and methotrexate

52. • PATHOLOGICALFRACTURES-Occursin abone
that is made weak by somedisease.
Causes-
Inflammatory- Osteomyelitis
Neoplastic- giant cell tumour, Ewingssarcoma,
secondaries

53. PATHOLOGIC
FRACTURES
 Often need surgery
 diagnostic workup
important
 prognosis dependent
on biology of lesion