Types

You may hear some of these terms used by the doctors to describe your fracture. For a more complete list of terms that are applied to injuries, please refer to the fracture glossary.

[LINK: Fracture glossary]

Greenstick/Torus

These terms are used for incomplete fractures of children. In a greenstick fracture the bone deforms (bends). There is a break on the convex (outer) side of the bend and just bending on the concave (inner) side. This is similar to what happens when you bend a sappy green twig too far.

A torus fracture is a compression injury in children’s bones. The elastic bone does not fully break but buckles.

Growth Plate Injuries

Bone only grows longer at each end. There is a special region near either end of a long bone called the growth plate. Injuries to this area need special treatment to avoid problems with future growth.

Stress Fracture

These fractures occur in normal bone subjected to severe repetitive loading as in military or sports training. These are fatigue fractures. Stress fractures also occur in abnormally weak bone under normal stresses (insufficiency fractures). The leg is the most common site for stress fractures which are common in the shin, the foot and the hip.

Nondisplaced

A nondisplaced fracture is one in which the fracture fragments stay in the correct position. It doesn’t mean it was never displaced. Usually at the time of injury the fracture fragments come quite widely apart but they may close back together giving the (misleading) appearance of a simple crack in the bone.

Displaced

The broken pieces of bone nearly always separate at the instant of injury. Often they do not come back together accurately and the fragments are not lined up. Displacement is considered in three planes, angulation, translation and rotation (see glossary). Collapse or shortening of the fracture is also a concern. The treatment of fractures often includes measures to straighten the bone and reduce the amount of displacement. This is called reducing the fracture.

Intraarticular

When breaks extend inside joints they are called intraarticular fractures. Bone ends are covered with a special slippery, smooth surface composed of cartilage so that friction and wear between moving bones is minimized. If the fracture line enters the joint there is a risk that the joint surface has been damaged and/or the joint is no longer smooth. It is very important that the fracture fragments are moved back to their original nondisplaced position (reduced) and they may need to be held there with pins or screws to prevent movement while the bone heals. Irregularities in the joint surface after an intraarticular fracture lead to premature wear and osteoarthritis of the joint.

Compound (Open)

In some injuries the skin is broken and the broken bone ends may stick out into the wound. The bone is contaminated by bacteria from outside the body in this situation. This injury has to be treated by surgery to decrease the chance of getting an infection in the site of the fracture. Infection is more likely the more serious the wound is, the more contaminated and the more extensive the injuries to muscles and blood vessels. The term compound is also used to refer to open fractures.

Pathological

When the bone breaks into an area weakened by abnormal bone or by abnormal deposits in bone it is called a pathological fracture. (see above: Bone Abnormality). Management of pathological fractures is more complex because of issues with the primary disease, general health of the patient, and problems with bone healing.

Comminuted

Comminuted means splintered. If there are more than two fragments the fracture is considered comminuted. The extent of fragmentation affects treatment because a very comminuted fracture is more likely to be unstable. The blood supply of the multiple fragments may be damaged and this can affect healing.

Stable

A stable fracture is likely to stay in a good position during the healing process. Even so some form of splinting such as a cast is needed to decrease the chance of the fracture losing position. Orthopaedic surgeons assess stability on the basis of the shape of the fracture, displacement, and any forces likely to push or pull the fracture fragments out of position.

Unstable

An unstable fracture is likely to become more displaced with time. This is often considered a reason to undertake surgery to fix the bone fragments together in a good position and convert the fracture from unstable to stable. Unstable fractures of the spine are particularly concerning because of the possibility of nerve damage as the fracture displaces or collapses.

Transverse/Oblique/Spiral

Transverse, oblique and spiral are terms used to describe the shape of the fracture. See the glossary for details.

Associated Injuries

Although the focus of attention and treatment is on the injury to the bone, there are always injuries to other structures in the limb that is broken. Most of these heal by themselves but they contribute to the overall problem and may cause significant symptoms.

Muscle/Tendon

As described above, the muscle near a broken bone is torn at the time of the injury. Most often this will form scar tissue and heal without intervention. However if a tendon is injured it may need to be repaired surgically. When the doctors and nurses ask you to move toes and fingers in an injured limb they are checking in part to make sure the muscles and tendons are working. Occasionally a part of the muscle or a tendon can get trapped between two parts of a fracture and prevent reduction. This needs to be corrected and may require surgery.

Dislocation

The forces that break the bone may also dislocate adjacent joints. This must be recognized and treated for the limb to function normally once everything has healed up.

Nerves

Nerves that pass through the area of injury may be stretched, torn, compressed or trapped. If nerves don’t work you would be unable to move joints, fingers or toes in the lower part of the limb and some skin areas would be numb. This is another reason why the medical team keep asking about sensation and movement.

Blood Vessels

Torn or compressed arteries and veins virtually always occur with fractures. That is why they bleed. Bone itself has a blood supply and the bone’s blood vessels are ruptured along with the rest of the bone. However, it is much more serious if larger blood vessels outside the bone are cut, torn or compressed by the injury. The loss of blood itself causes swelling, pain and bruising and may be enough to cause shock through loss of blood. Equally important, the blood supply to the rest of the limb may be cut off causing major problems. Assessment of the blood supply involves feeling for pulses and looking at warmth and skin color over the whole limb. This will be done many times by the treating team.

Skin

If the skin is broken when a fracture occurs then the injury is an open fracture and carries a higher risk of infection. Even if it is not broken the skin and underlying fatty tissue is often injured with scratches, abrasions (road rash), swelling, bruising and shear injuries being common. Shear injuries occur when the limb is twisted during the injury. One layer of the skin is sheared away from the next and the gap fills up with fluid. At the surface of the skin this causes dramatic fracture blisters.

At deeper layers there may be cavities between the fatty layer of the skin and the deeper muscle layer. These cavities fill with blood and can be a source of trouble.