Fracture types

Uncomplicated fracture: fracture where the adjacent skin is intact.
Complicated/open fracture: fracture with skin penetration of a fracture fragment.

Comminuted fracture: fracture with > 2 bone fragments.

Intra-articular fracture: fracture line continues up to the joint surface (fig. 2).

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Complicated intra-articular comminuted fracture of the elbow.
Complicated intra-articular comminuted fracture of the elbow.

Figure 2. Left elbow. Open intra-articular comminuted fracture of the proximal radius and ulna, with air in the soft tissues.

Stress fracture: fracture resulting from excessive stress on the bone. Can be seen e.g. in the metatarsal bones of fanatical sportsmen (fig. 3a).

Pathological fracture: fracture line at the level of abnormal bone, as in a bone metastasis or bone cyst (fig. 3b).

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A stress fracture and a pathological fracture.
A stress fracture and a pathological fracture.

Figure 3. A (cloudy) periostal reaction around the mid shaft of metatarsal III, image of a stress fracture (a).  Pathological humeral shaft fracture in a child with a bone cyst (b) Normal epiphyseal plates (= growth plates).

Insufficiency fracture: fracture secondary to reduced bone strength, e.g. osteoporotic vertebral collapse.

Avulsion fracture: fracture at the site of a tendon insertion. The bone of the insertion site is ripped loose by the tendon/muscle (excessive traction on the bone).

Pediatric

Greenstick fracture: incomplete fracture where the bone is bent (one-sided cortical interruption). These fractures are seen in the distal radius and ulna in particular (fig. 4).

Torus fracture (= buckle fracture): incomplete fracture creating a ‘buckle’ of the cortex. The picture resembles the bottom of a Greek pillar (fig. 4). Torus fractures heal quicker than greenstick fractures.

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Greenstick fracture of the radius and a torus fracture of the ulna.
Greenstick fracture of the radius and a torus fracture of the ulna.

Figure 4. Lateral image (a) and anteroposterior image (b) of a radial greenstick fracture and ulnar torus fracture.

Epiphysiolysis: fractures of the epiphyseal plate (=growth plate)

Classification according to Salter & Harris (fig. 5).
Type I: fracture through the epiphyseal plate.
Type II: fracture through the epiphyseal plate and the metaphysis (most common)
Type III: fracture through the epiphyseal plate and the epiphysis.
Type IV: fracture through the epiphyseal plate, metaphysis and epiphysis.
Type V: crush injury of the epiphysis.

Memory aid based on the epiphyseal plate: SALTeR Same level (I),Above (II), Lower (III), Through (IV), Ruined (V).

Epiphysiolysi; Salter & Harris classification.

Figure 5. Epiphysiolysis as per Salter & Harris classification.