Fracture of Bones; Types, Mechanism, Symptoms

Fracture of Bones








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Fracture of Bones is a medical condition in which there is a partial or complete break in the continuity of the bone. In more severe cases, the bone may be broken into several pieces.[rx] A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.[rx]

Types of Fracture of Bones

Mechanism

  • Traumatic fracture – This is a fracture due to sustained trauma. e.g., fractures caused by a fall, road traffic accident, fight, etc.
  • Pathologic fracture – A fracture through a bone that has been made weak by some underlying disease is called pathological fracture. e.g., a fracture through a bone weakened by metastasis. Osteoporosis is the most common cause of pathological fracture.
  • Periprosthetic fracture – This is a fracture at the point of mechanical weakness at the end of an implant

Soft-tissue involvement

  • Closed fractures are those in which the overlying skin is intact
  • Open/compound fractures involve wounds that communicate with the fracture, or where fracture hematoma is exposed, and may thus expose bone to contamination. Open injuries carry a higher risk of infection.
    • Clean fracture
    • Contaminated fracture

Displacement

  • Non-displaced
  • Displaced
    • Translated, or ad latus, with sideways displacement.[11]
    • Angulated
    • Rotated
    • Shortened

Fracture Pattern

  • Linear fracture – A fracture that is parallel to the bone’s long axis
  • Transverse fracture – A fracture that is at a right angle to the bone’s long axis
  • Oblique fracture – A fracture that is diagonal to a bone’s long axis (more than 30°)
  • Spiral fracture – A fracture where at least one part of the bone has been twisted
  • Compression fracture/wedge fracture – usually occurs in the vertebrae, for example when the front portion of a vertebra in the spine collapses due to osteoporosis (a medical condition which causes bones to become brittle and susceptible to fracture, with or without trauma)
  • Impacted fracture – A fracture caused when bone fragments are driven into each other
  • Avulsion fracture – A fracture where a fragment of bone is separated from the main mass

Fragments

  • Incomplete fracture – Is a fracture in which the bone fragments are still partially joined, in such cases, there is a crack in the osseous tissue that does not completely traverse the width of the bone.
  • Complete fracture – Is a fracture in which bone fragments separate completely.
  • Comminuted fracture – Is a fracture in which the bone has broken into several pieces.

Fracture types

  • Avulsion fracture
  • Articular surface injuries
    • Bone contusion
    • Chondral fracture
    • Subchondral fracture
    • Subchondral insufficiency fracture

Osteochondral fracture

  • Complete fracture
  • Transverse fracture
  • Oblique fracture
  • Spiral fracture
  • Longitudinal fracture
  • Comminuted fracture
  • segmental fracture
  • Incomplete fracture
    • Bowing fracture
    • Buckle fracture (torus)
    • Greenstick fracture
  • Compound fracture
    • Gustilo Anderson classification (compound fracture)
  • Pathological fracture
  • Stress fracture
    • insufficiency fracture
    • fatigue fracture
      • grey cortex sign

Fracture displacement

  • Fracture translation > off-ended fracture
  • Fracture angulation
  • Fracture rotation
  • Fracture length
    • distraction
    • impaction
    • shortening

Skull Fractures

  • The base of skull fractures
  • Occipital condyle fracture
  • Temporal bone fractures
    • Longitudinal fractures
    • Transverse fractures
    • Mixed fractures
    • Transsphenoidal basilar skull fracture
  • Skull vault fractures
    • Depressed skull fracture
    • Ping pong skull fracture

Facial fractures

  • Fractures involving a single facial buttress
  • Alveolar process fractures
  • Frontal sinus fracture
  • Isolated zygomatic arch fractures
  • Mandibular fracture
  • Nasal bone fracture
  • Orbital blow-out fracture
  • Paranasal sinus fractures

Complex fractures

  • Complex midfacial fracture
  • Le Fort fractures
  • Naso-orbitoethmoid (NOE) complex fracture
  • Zygomaticomaxillary complex fracture

Cervical spine fracture classification systems

  • AO classification of upper cervical injuries
  • AO classification of subaxial injuries
  • Anderson and D’Alonzo classification (odontoid fracture)
  • Levine and Edwards classification (hangman fracture)
  • Roy-Camille classification (odontoid process fracture )
  • Allen and Ferguson classification (subaxial spine injuries)
  • subaxial cervical spine injury classification (SLIC)

Thoracolumbar spinal fracture classification systems

  • AO classification of thoracolumbar injuries
  • Magerl classification
  • McAfee classification
  • Thoracolumbar injury classification and severity score (TLICS)
  • Limbus fractures
    • Three column concept of spinal fractures (Denis classification)
    • Classification of sacral fractures
    • AO classification of sacral injuries

Cervical spine fractures

  • clay-shoveler’s fracture
  • dens fracture
  • hangman fracture
  • Jefferson fracture
  • extension teardrop fracture
  • flexion teardrop fracture
  • cervical spine floating pillar

Thoracic spine fractures

  • Chance fracture
  • Transverse process fracture
  • Spondylolysis
    • lumbar spine fractures
    • sacral fractures

Spinal fracture types

  • Burst fracture
  • Chance fracture
  • Clay-shoveler fracture
  • Chalk stick fracture
  • Dens fracture
  • Extension teardrop fracture
  • Flexion teardrop fracture
  • Hangman fracture
  • Jefferson fracture
  • Vertebra plana
  • Wedge fracture

Rib fractures

  • Flail chest
  • Stove-in chest
  • Sternal fractures

Upper limb fractures classification

  • Rockwood classification (acromioclavicular joint injury)
  • Neer classification (proximal humeral fracture)
  • AO classification (proximal humeral fracture)
  • Milch classification (lateral humeral condyle fracture)
  • Weiss classification (lateral humeral condyle fracture)
  • Bado classification of Monteggia fracture-dislocations (radius-ulna)
  • Mason classification (radial head fractures
  • Frykman classification (distal radial fracture)

Mayo classification (scaphoid fracture)

  • Hintermann classification (gamekeeper’s thumb)
  • Eaton classification (volar plate avulsion injury)
  • Keifhaber-Stern classification (volar plate avulsion injury)

Upper limb fractures by region

Shoulder

  • Clavicular fracture
  • Scapular fracture
  • Acromion fracture
  • Coracoid process fracture
  • Glenoid fracture
    • Bankart lesion
    • reverse Bankart lesion

Humeral head fracture

  • Hill-Sachs lesion
  • reverse Hill-Sachs lesion
  • proximal humeral fracture
  • humeral neck fracture

Arm

  • Humeral shaft fracture

Elbow

  • Humeral condyle fracture
  • Lateral humeral condyle fracture
  • Medial humeral condyle fracture
  • Epicondyle fracture
  • Medial epicondyle fracture
  • Lateral epicondyle fracture
  • Olecranon fracture
  • Supracondylar fracture (extension)
  • Supracondylar fracture (flexion)
  • Radial head fracture
  • Radial neck fracture

Forearm

  • Forearm fracture-dislocation
  • Essex-Lopresti fracture-dislocation
  • Galeazzi fracture-dislocation
  • Monteggia fracture-dislocation
  • Forearm fracture
  • nightstick fracture

Wrist > distal radial fracture

  • Chauffeur fracture
  • Colles fracture
  • Smith fracture
  • Barton fracture
  • reverse Barton fracture

Distal ulnar fracture

  • Ulnar styloid fracture
  • Carpal bones
  • Humpback deformities
  • Scaphoid fracture
  • Scaphoid non-union
  • A scaphoid non-union advanced collapse

Lunate fracture

  • Perilunate fracture-dislocation
  • Lunate dislocation
  • Capitate fracture
  • Triquetral fracture
  • Pisiform fracture
  • Hamate fracture
  • Hook of hamate fracture
  • Trapezoid fracture
  • Trapezium fracture

Hand

  • Metacarpal fractures > boxer fracture &  reverse Bennett fracture-dislocation

Fractures of the thumb

  • Gamekeeper thumb
  • Epibasal fracture of the thumb
  • Rolando fracture
  • Bennett fracture-dislocation

Phalanx fractures

  • Proximal phalanx fracture
  • Middle phalanx fracture
  • Volar plate avulsion injury
  • Distal phalanx fracture
    • Jersey finger
    • mallet finger

Lower limb fractures > classification by region

  • pelvis
  • Judet and Letournel classification (acetabular fracture)
  • Young and Burgess classification of pelvic ring fractures

Hip

  • Pipkin classification (femoral head fracture)
  • Garden classification (hip fracture)
  • American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture)
  • Cooke and Newman classification (periprosthetic hip fracture)
  • Johansson classification (periprosthetic hip fracture)
  • Vancouver classification (periprosthetic hip fracture)

Femoral

  • Winquist classification (femoral shaft fracture)

Knee

  • Schatzker classification (tibial plateau fracture)
  • Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture)

Tibia/fibula

  • Watson-Jones classification (tibial tuberosity avulsion fracture)

Ankle

  • Lauge-Hansen classification (ankle injury)
  • Danis-Weber classification (ankle fracture)

Foot

  • Berndt and Harty classification (osteochondral lesions of the talus)
  • Sanders CT classification (calcaneal fracture)
  • Hawkins classification (talar neck fracture)
  • Myerson classification (Lisfranc injury)
  • Nunley-Vertullo classification (Lisfranc injury)

Lower limb fractures by region> pelvic fracture

  • Malgaigne fracture
  • Wind-swept pelvis fracture
  • Pelvic bucket handle fracture
  • Pelvic insufficiency fracture
  • Parasymphyseal insufficiency fracture
  • anterior inferior iliac spine avulsion
  • Duverney fracture
  • Open book fracture
  • Pubic rami fracture
  • Anterior superior iliac spine (ASIS) avulsion

Sacral fracture

  • Sacral insufficiency fractures
  • Honda sign

Hip

  • Acetabular fracture
  • Femoral head fracture
  • Femoral neck fracture
    • subcapital fracture
    • transcervical fracture
    • basicervical fracture

Trochanteric fracture

  • Pertrochanteric fracture
  • Intertrochanteric fracture
  • Subtrochanteric fracture

Thigh

  • Mid-shaft fracture
  • Bisphosphonate-related fracture

Knee > avulsion fractures

  • Segond fracture
  • Reverse Segond fracture
  • Anterior cruciate ligament avulsion fracture
  • Posterior cruciate ligament avulsion fracture
  • Arcuate complex avulsion fracture (arcuate sign)
  • Biceps femoris avulsion fracture
  • Iliotibial band avulsion fracture
  • Semimembranosus tendon avulsion fracture
  • Stieda fracture (MCL avulsion fracture)
  • Patella fracture
  • Tibial plateau fracture

leg

  • Tibial tuberosity avulsion fracture
  • Tibial shaft fracture
  • Fibular shaft fracture
  • Maisonneuve fracture

Ankle

  • Bimalleolar fracture
  • Trimalleolar fracture
  • Triplane fracture
  • Tillaux fracture
  • Bosworth fracture
  • Pilon fracture
  • Wagstaffe-Le Forte fracture

Foot

  • Tarsal bones
  • Chopart fracture
  • Calcaneal fracture
  • Lover’s fracture
  • Calcaneal tuberosity avulsion fracture

Talus fracture

  • Talar body fractures
  • Talar dome osteochondral fracture
  • Posterior talar process fracture
  • Lateral talar process fracture
  • Talar neck fracture
    • aviator fracture
    • talar head fracture
    • navicular fracture
    • medial cuneiform fracture
    • intermediate cuneiform fracture
    • lateral cuneiform fracture
    • cuboid fracture
    • nutcracker fracture

Metatarsal Bones

  • March fracture
  • Lisfranc fracture-dislocation
  • 5th metatarsal fracture
  • Stress fracture of the 5th metatarsal
  • Jones fracture
  • Pseudo-Jones fracture
  • Avulsion fracture of the proximal 5th metatarsal
  • phalanges

Classification parameter

fracture types

      • avulsion fracture
      • articular surface injuries
        • bone contusion
        • chondral fracture
        • subchondral fracture
          • subchondral insufficiency fracture
        • osteochondral fracture
      • complete fracture
        • transverse fracture
        • oblique fracture
        • spiral fracture
        • longitudinal fracture
        • comminuted fracture
        • segmental fracture
      • incomplete fracture
        • bowing fracture
        • buckle fracture (torus)
        • greenstick fracture
      • infraction
      • compound fracture
        • Gustilo Anderson classification (compound fracture)
      • pathological fracture
      • stress fracture
        • insufficiency fracture
        • fatigue fracture
          • grey cortex sign
    • fracture displacement
      • fracture translation
        • off-ended fracture
      • fracture angulation
      • fracture rotation
      • fracture length
        • distraction
        • impaction
        • shortening
  • skull fractures[–]
    • base of skull fractures
      • occipital condyle fracture
      • temporal bone fractures
        • longitudinal fractures
        • transverse fractures
        • mixed fractures
      • transsphenoidal basilar skull fracture
    • skull vault fractures
      • depressed skull fracture
      • ping pong skull fracture
  • facial fractures[–]
    • fractures involving a single facial buttress
      • alveolar process fractures
      • frontal sinus fracture
      • isolated zygomatic arch fractures
      • mandibular fracture
      • nasal bone fracture
      • orbital blow-out fracture
      • paranasal sinus fractures
    • complex fractures
      • complex midfacial fracture
      • Le Fort fractures
      • naso-orbitoethmoid (NOE) complex fracture
      • zygomaticomaxillary complex fracture
  • spinal fractures[–]
    • classification (AO Spine classification systems)
      • cervical spine fracture classification systems
        • AO classification of upper cervical injuries
        • AO classification of subaxial injuries
        • Anderson and D’Alonzo classification (odontoid fracture)
        • Levine and Edwards classification (hangman fracture)
        • Roy-Camille classification (odontoid process fracture )
        • Allen and Ferguson classification (subaxial spine injuries)
        • subaxial cervical spine injury classification (SLIC)
      • thoracolumbar spinal fracture classification systems
        • AO classification of thoracolumbar injuries
        • Magerl classification
        • McAfee classification
        • thoracolumbar injury classification and severity score (TLICS)
        • limbus fractures
      • three column concept of spinal fractures (Denis classification)
      • classification of sacral fractures
        • AO classification of sacral injuries
    • spinal fractures by region
      • cervical spine fractures
        • clay-shoveler’s fracture
        • dens fracture
        • hangman fracture
        • Jefferson fracture
        • extension teardrop fracture
        • flexion teardrop fracture
        • cervical spine floating pillar
      • thoracic spine fractures
        • Chance fracture
        • transverse process fracture
        • spondylolysis
      • lumbar spine fractures
      • sacral fractures
    • spinal fracture types
      • burst fracture
      • Chance fracture
      • clay-shoveler fracture
      • chalk stick fracture
      • dens fracture
      • extension teardrop fracture
      • flexion teardrop fracture
      • hangman fracture
      • Jefferson fracture
      • vertebra plana
      • wedge fracture
  • rib fractures[–]
    • flail chest
    • stove-in chest
  • sternal fractures
  • upper limb fractures
    • classification
      • Rockwood classification (acromioclavicular joint injury)
      • Neer classification (proximal humeral fracture)
      • AO classification (proximal humeral fracture)
      • Milch classification (lateral humeral condyle fracture)
      • Weiss classification (lateral humeral condyle fracture)
      • Bado classification of Monteggia fracture-dislocations (radius-ulna)
      • Mason classification (radial head fracture)
      • Frykman classification (distal radial fracture)
      • Mayo classification (scaphoid fracture)
      • Hintermann classification (gamekeeper’s thumb)
      • Eaton classification (volar plate avulsion injury)
      • Keifhaber-Stern classification (volar plate avulsion injury)
    • upper limb fractures by region[–]
      • shoulder
        • clavicular fracture
        • scapular fracture
          • acromion fracture
          • coracoid process fracture
          • glenoid fracture
            • Bankart lesion
            • reverse Bankart lesion
        • humeral head fracture
          • Hill-Sachs lesion
          • reverse Hill-Sachs lesion
        • proximal humeral fracture
        • humeral neck fracture
      • arm
        • humeral shaft fracture
      • elbow
        • humeral condyle fracture
          • lateral humeral condyle fracture
          • medial humeral condyle fracture
        • epicondyle fracture
          • medial epicondyle fracture
          • lateral epicondyle fracture
        • olecranon fracture
        • supracondylar fracture (extension)
        • supracondylar fracture (flexion)
        • radial head fracture
        • radial neck fracture
      • forearm
        • forearm fracture-dislocation
          • Essex-Lopresti fracture-dislocation
          • Galeazzi fracture-dislocation
          • Monteggia fracture-dislocation
        • forearm fracture
          • nightstick fracture
      • wrist
        • distal radial fracture
          • Chauffeur fracture
          • Colles fracture
          • Smith fracture
          • Barton fracture
          • reverse Barton fracture
        • distal ulnar fracture
          • ulnar styloid fracture
      • carpal bones
        • scaphoid fracture
          • scaphoid non-union
            • scaphoid non-union advanced collapse
          • humpback deformity
        • lunate fracture
          • perilunate fracture-dislocation
          • lunate dislocation
        • capitate fracture
        • triquetral fracture
        • pisiform fracture
        • hamate fracture
          • hook of hamate fracture
        • trapezoid fracture
        • trapezium fracture
      • hand
        • metacarpal fractures
          • boxer fracture
          • reverse Bennett fracture-dislocation
        • fractures of the thumb
          • gamekeeper thumb
          • epibasal fracture of the thumb
          • Rolando fracture
          • Bennett fracture-dislocation
        • phalanx fractures
          • proximal phalanx fracture
          • middle phalanx fracture
            • volar plate avulsion injury
          • distal phalanx fracture
            • Jersey finger
            • mallet finger
  • lower limb fractures
    • classification by region
      • pelvis
        • Judet and Letournel classification (acetabular fracture)
        • Young and Burgess classification of pelvic ring fractures
      • hip
        • Pipkin classification (femoral head fracture)
        • Garden classification (hip fracture)
        • American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture)
        • Cooke and Newman classification (periprosthetic hip fracture)
        • Johansson classification (periprosthetic hip fracture)
        • Vancouver classification (periprosthetic hip fracture)
      • femoral
        • Winquist classification (femoral shaft fracture)
      • knee
        • Schatzker classification (tibial plateau fracture)
        • Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture)
      • tibia/fibula
        • Watson-Jones classification (tibial tuberosity avulsion fracture)
      • ankle
        • Lauge-Hansen classification (ankle injury)
        • Danis-Weber classification (ankle fracture)
      • foot
        • Berndt and Harty classification (osteochondral lesions of the talus)
        • Sanders CT classification (calcaneal fracture)
        • Hawkins classification (talar neck fracture)
        • Myerson classification (Lisfranc injury)
        • Nunley-Vertullo classification (Lisfranc injury)
    • lower limb fractures by region
      • pelvic fracture
        • Malgaigne fracture
        • wind-swept pelvis fracture
        • pelvic bucket handle fracture
        • pelvic insufficiency fracture
          • parasymphyseal insufficiency fracture
        • anterior inferior iliac spine avulsion
        • Duverney fracture
        • open book fracture
        • pubic rami fracture
        • anterior superior iliac spine (ASIS) avulsion
      • sacral fracture
        • sacral insufficiency fractures
          • Honda sign
      • hip
        • acetabular fracture
        • femoral head fracture
        • femoral neck fracture
          • subcapital fracture
          • transcervical fracture
          • basicervical fracture
        • trochanteric fracture
          • pertrochanteric fracture
          • intertrochanteric fracture
          • subtrochanteric fracture
      • thigh
        • mid-shaft fracture
        • bisphosphonate-related fracture
      • knee
        • avulsion fractures
          • Segond fracture
          • reverse Segond fracture
          • anterior cruciate ligament avulsion fracture
          • posterior cruciate ligament avulsion fracture
          • arcuate complex avulsion fracture (arcuate sign)
          • biceps femoris avulsion fracture
          • iliotibial band avulsion fracture
          • semimembranosus tendon avulsion fracture
          • Stieda fracture (MCL avulsion fracture)
        • patella fracture
        • tibial plateau fracture
      • leg
        • tibial tuberosity avulsion fracture
        • tibial shaft fracture
        • fibular shaft fracture
        • Maisonneuve fracture
      • ankle
        • bimalleolar fracture
        • trimalleolar fracture
        • triplane fracture
        • Tillaux fracture
        • Bosworth fracture
        • pilon fracture
        • Wagstaffe-Le Forte fracture
      • foot
        • tarsal bones
          • Chopart fracture
          • calcaneal fracture
            • lover’s fracture
            • calcaneal tuberosity avulsion fracture
          • talus fracture
            • talar body fractures
              • talar dome osteochondral fracture
              • posterior talar process fracture
              • lateral talar process fracture
            • talar neck fracture
              • aviator fracture
            • talar head fracture
          • navicular fracture
          • medial cuneiform fracture
          • intermediate cuneiform fracture
          • lateral cuneiform fracture
          • cuboid fracture
            • nutcracker fracture
        • metatarsal bones
          • general
            • march fracture
            • Lisfranc fracture-dislocation
          • 5th metatarsal fracture
            • stress fracture of the 5th metatarsal
            • Jones fracture
            • pseudo-Jones fracture
            • avulsion fracture of the proximal 5th metatarsal
        • phalanges

Symptoms of Fracture of Bones

Although bone tissue itself contains no nociceptors, the bone fracture is painful for several reasons:[rx]

  • Breaking in the continuity of the periosteum, with or without similar discontinuity in endosteum, as both contain multiple pain receptors.
  • Edema of nearby soft tissues caused by bleeding of broken periosteal blood vessels evokes pressure pain.
  • Involuntary muscle spasms trying to hold bone fragments in place.
  • Hematoma on the fracture site.

Damage to adjacent structures such as nerves, muscles or blood vessels, spinal cord, and nerve roots (for spine fractures), or cranial contents (for skull fractures) may cause other specific signs and symptoms.

Complications

An old fracture with nonunion of the fracture fragments

Some fractures may lead to serious complications including a condition known as compartment syndrome. If not treated, eventually, compartment syndrome may require amputation of the affected limb. Other complications may include non-union, where the fractured bone fails to heal or mal-union, where the fractured bone heals in a deformed manner.

Complications of fractures may be classified into three broad groups, depending upon their time of occurrence. These are as follows –

  • Immediate complications – occurs at the time of the fracture.
  • Early complications – occurring in the initial few days after the fracture.
  • Late complications – occurring a long time after the fracture.
Immediate complications Early complications Late complications
Systemic

  • Hypovolaemic shock
Systemic

  • Hypovolaemic shock
  • ARDS – Adult respiratory distress syndrome
  • Fat embolism syndrome
  • Deep vein thrombosis
  • Pulmonary syndrome
  • Aseptic traumatic fever
  • Septicemia (in open fracture )
  • Crush syndrome
Imperfect union of the fracture

  • Delayed union
  • Nonunion
  • Malunion
  • Cross union
Local

  • Injury to major vessels
  • Injury to muscles and tendons
  • Injury to joints
  • Injury to viscera
Local

  • Infection
  • Compartment syndrome
Others

  • Avascular necrosis
  • Shortening
  • Joint stiffness
  • Sudeck’s dystrophy
  • Osteomyelitis
  • Ischaemic contracture
  • Myositis ossificans
  • Osteoarthritis

References

Fracture of Bones

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