Differentiate and identify common classifications of skeletal fractures.
Discuss fracture treatment options, as well as signs and possible complications of fracture healing.
Skeletal System: Fracture Classifications
3.1.1 Avulsion
3.1.2 Bennett's
3.1.3 Bimalleolar
3.1.4 Blow-out
3.1.5 Boxer's
3.1.6 Clay Shovelers
3.1.7 Closed
3.1.8 Colle's
3.1.9 Comminuted
3.1.10 Complete
3.1.11 Compound/Open
3.1.12 Compression
3.1.13 Contrecoup
3.1.14 Depressed
3.1.15 Displaced
3.1.16 Galeazzi
3.1.17 Hangman's
3.1.18 Impacted
3.1.19 Incomplete/Greenstick
3.1.20 Intertrochanteric
3.1.21 Jefferson
3.1.22 Jones
3.1.23 Linear
3.1.24 LeFort
3.1.25 Longitudinal
3.1.26 March
3.1.27 Monteggia
3.1.28 Oblique
3.1.29 Pathological
3.1.30 Salter-Harris
3.1.31 Simple
3.1.32 Smith's
3.1.33 Spiral
3.1.34 Supracondylar
3.1.35 Transverse
3.1.36 Trimalleolar
3.1.37 Tripod
3.1.38 Undisplaced
Fracture Definition
Fractures: Defined as a disruption of bone caused by mechanical forces applied either directly to the bone or transmitted along the shaft of a bone.
Some fractures are subtle and difficult to detect, known as occult fractures:
Typically appears as a radiolucent line crossing the bone and disrupting the cortical margins.
Overlap of fragments may produce a radiopaque line.
Secondary signs include joint effusion, soft tissue swelling, and interruption of the normal pattern of bony trabeculae.
Role of Medical Radiation Technologists (MRTs)
MRTs are expected to have the knowledge and skills to perform the best diagnostic imaging tests possible.
Requires understanding anatomy and how to best visualize on radiographic projections, adjusting beam geometry and technical acquisition factors as needed.
Ability to adapt to provide the best diagnostic imaging, assess patient's conditions, abilities and needs, and identify common skeletal abnormalities.
Fracture Classification & Treatment
Classification Criteria
Fractures are classified by:
Extent
Direction
Position
Number of fracture lines
Integrity of the overlying skin
Complete vs Incomplete Fracture
Complete Fracture: Results in a discontinuity between two or more fragments.
Incomplete Fracture: Causes only partial discontinuity, with a portion of the cortex remaining intact.
Closed vs Open Fracture
Closed Fracture: The overlying skin is intact and the bone does not break through.
Open Fracture: The overlying skin is disrupted and the bone is exposed, also called a compound fracture.
Transverse vs Longitudinal Fracture
Transverse Fracture: Runs at a right angle or perpendicular to the long axis of a bone, commonly results from a direct blow or fracture within pathologic bone.
Longitudinal Fracture: Occurs along the axis of the bone, mostly used for long-bone fractures.
Oblique vs Spiral Fracture
Oblique Fracture: Runs at 45 degrees to the long axis of the bone caused by angulation or both angulation and compression forces.
Spiral Fracture: Encircles the shaft, generally longer than oblique fractures, results from torsional forces, often associated with high impact and displacement.
Avulsion and Comminuted Fractures
Avulsion Fracture
Fragments are torn from the bone, usually due to indirectly applied tension forces within attached ligaments and tendons.
Comminuted Fracture
Composed of more than two bone fragments resulting in a "shattered" appearance.
Butterfly and Segmental Fractures
Butterfly Fracture
Elongated triangular fragment of cortical bone generally detached from two other larger fragments, results from two oblique fracture lines.
Segmental Fracture
A segment of the shaft is isolated by proximal and distal lines of fracture, which increases the risk of devascularization.
Compression and Depressed Fractures
Compression Fracture
Results from a compression force causing compaction of bone trabeculae, mainly in the vertebral body.
Depressed Fracture
Occurs in the skull when a force produces a comminuted fracture with portions of the skull forced inward.
Stress and Pathological Fractures
Stress Fracture
Also called fatigue fractures, result from repeated stresses on bone that wouldn't normally cause a fracture. Most common in lower extremities.
Common sites include shafts of second and third metatarsals, calcaneus, proximal and distal shafts of tibia and fibula, shaft and neck of femur, ischial and pubic rami.
Pathological Fracture
Happens at a site of weakness in the bone due to tumors, infections, or metabolic bone disease.
Greenstick and Torus Fractures
Greenstick Fracture
One cortex remains intact while the opposite cortex bends and breaks, considered an incomplete fracture, mostly prevalent in infants and children.
Torus or Buckle Fracture
Characterized by bulging of the bone cortex with one cortex intact; may only be diagnosed via angulation.
Undisplaced vs Displaced Fractures
Undisplaced Fracture
Occurs when there is a plane of cleavage in the bone without angulation or separation.
Displaced Fracture
Indicates separation of bone fragments with the direction of displacement describing the relationship of the distal fragment to the proximal one.
Agnulation and Dislocation
Angulation
Refers to an angular deformity between major fragment axes.
Dislocation
Refers to displacement of a bone from its normal articulation, partially seen as subluxation.
Salter-Harris Fractures
Refers to injuries through the growth plate of long bones. If untreated, it could affect growth. Classification includes Types I - V.
Type II is the most common with potential complications affecting skeletal growth, especially in children mostly assigned male at birth.
Symptoms of Fractures
Pain followed by swelling around the fracture area.
Painful to touch.
Inability to put weight on the affected limb.
Limited range of motion.
Bone deformity.
Diagnosis & Management of Fractures
Initial radiographs to verify suspected fractures and assess underlying bone conditions.
Post-reduction radiographs to determine anatomic position of fragments.
Follow-up radiographs to monitor healing and exclude complications.
Role of MRT in Imaging Fractures
Imaging the injured body part with two views at 90 degrees to assess continuity or displacement of fractures.
Imaging should include joints above and below to check for secondary injuries.
It’s crucial to avoid manipulating the area if there’s a visible disturbance.
Treatment Objectives for Fractures
Restore function and stability with minimal residual deformity.
Treatment Methods for Fractures
External or Closed Reduction
Treated by manipulation without surgery; sedation may be necessary.
Open Reduction
Involves surgical manipulation of fragments with hardware application to maintain reduction.
Internal Fixation
Utilizes plates, screws, rods, and nails for maintaining reduction.
Open Reduction Internal Fixation (ORIF) involves both surgical procedures.
External Fixation
Accomplished through splints, external devices or casts.
Fractures & Healing Process
Radiographic evidence of healing shows continuous external bridge of callus across the fracture line.
At least two views at 90 degrees are required to confirm healing.
Delayed union, non-union, and malunion are potential complications requiring careful monitoring and intervention.
Delayed Union
Refers to fractures taking longer to heal than normal, potentially due to infection or inadequate immobilization.
Non-union
Describes fractures that do not heal even with prolonged immobilization, requiring surgical intervention.
Malunion
Occurs when fractured fragments heal in a faulty position, potentially requiring correction.
Summary of Discussion
Covered fracture classifications and types, treatment options, and healing processes. Key terms and applications will be integral in MRT practice.
References
Campagne, D. (2025). Vertebral compression fractures. MSD Manual Professional Edition.
Dixon, A. (2013). Spiral fracture of femur. Radiopaedia.org.
Eisenberg, R. L., Johnson, N. M. (2021). Comprehensive Radiographic Pathology. Elsevier.
El-Feky, M., Jones, J. (2009). Pathological fracture. Radiopaedia.org.
Skalski, M. (2016). Fracture with butterfly fragment. Radiopaedia.org.
Next Steps
Upcoming lesson will delve deeper into common fractures of the upper and lower extremities, spine, skull, and facial bones.