Define the parameters that allow you to describe a long bone fracture pattern over the phone.
Accurate clinical description of a fracture is vital for medical communication as well as clinical decision-making regarding management of the injury.
There are four main components to fracture description: (1) location (region) within the bone, (2) fracture pattern, (3) displacement and (4) soft tissue envelope, each of which are expanded upon below.
Location in the bone
- Physis (growth plate in growing child) or “Physeal scar”
(once growth plate fuses in adult), Shown in red. A fracture occurring in this area would be described as a "physeal fracture".
- Epiphysis: the ends of the bone forming part of the joint articulation, Shown in green. A fracture occurring in this area would be described as an "epiphyseal fracture".
- Metaphysis: the “flared” portion of the bone between the epiphysis and the shaft, Shown in purple. A fracture occurring in this area would be described as a "metaphyseal fracture".
- Diaphyseal: The shaft of the long bone. This is further categorized as proximal, middle, or distal diaphysis, Shown in yellow. A fracture occurring in this area would be described as a "diaphyseal fracture".
- Transverse: Fracture line is perpendicular to the axis of the bone (Figure 2)
- Oblique: Angular fracture line, caused by angular or rotational force (Figure 3)
- Spiral: Complex multiplanar fracture line caused by rotational force (Figure 4)
- Comminuted: More than two fracture fragments (Figure 5)
- Segmental: Separate segment of bone bordered by distinct fracture lines (Figure 6)
- Depressed / Impacted: Impaction of bone at the joint surface (Figure 7)
- Avulsion: A (usually small) segment of bone that is pulled off (“avulsed”) by the attachment of a tendon or ligament (Figure 8).
Nondisplaced: fracture fragments are in full contact and in anatomic alignment.
Displaced: fracture fragments are not in anatomical alignment
(Note the direction of displacement is described as the direction that the more distal fracture fragment has moved relative to the more proximal fragment).
Displaced fractures are further described as:
- Distracted: fracture fragments are separated by a gap,
- Translated: side-to-side displacement, usually stated in millimeters or as a percentage of the size of the bone at fracture site. Figure 9 shows a tibia fracture with lateral translation of approximately 40% of the diameter of the bone at that location.
- Angulated: Described based on the direction of distal fragment, relative to the midline.
The complementary term is varus, where the direction of distal fragment is medial, as seen in Figure 11.
Soft Tissue Envelope
- Closed: skin/soft tissue over and near fracture is intact,
- Open: skin/soft tissue over and near the fracture is lacerated or abraded; the fracture is exposed to the outside environment. (The older term for this is a "compound fracture".)
Additional descriptive terms:
- Periarticular: near and likely involving a joint,
- Pathological: underlying bone is not normal (e.g., tumor),
- Greenstick/buckle: partial fractures in children,
NOTE: The precursor of all nomenclature is the name of the bone -- it is imperative to learn them all. Some are easy (femur), some are obscure (medial cuneiform), some have two names (the trapezium is also known as the greater multangular), some appear twice (e.g., the navicular, also known as the scaphoid is found in the wrist and foot - though many use the word navicular to denote the bone in the foot, and scaphoid in the wrist). The names of the bones must be mastered. Describing a “fibia” fracture will make you sound at best ill-informed.