to identify possible fractures after a knee injury A bone fracture may be diagnosed based on the history given and the physical examination performed.
Radiographic imaging is often performed to confirm the diagnosis. Under certain circumstances, radiographic examination of the nearby joints is indicated to exclude dislocations and fracture-dislocations. In situations where projectional radiography alone is insufficient,
Computed Tomography (CT) or
Magnetic Resonance Imaging (MRI) may be indicated.
Classification In
orthopedic medicine, fractures are classified in various ways. Historically, they are named after the physician who first described the fracture conditions; however, there are more systematic classifications as well. They may be divided into stable versus unstable depending on the likelihood that they may shift further.
Mechanism •
Traumatic fracture – 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 a pathological fracture. e.g., a fracture through a bone weakened by
metastasis.
Osteoporosis is the most common cause of pathological fracture. •
Periprosthetic fracture – a fracture at the point of mechanical weakness at the end of an
implant.
Soft-tissue involvement • Closed/simple 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. Reports indicate an incidence of infection after internal fixation of closed fractures of 1-2%, rising to 30% in open fractures. • Clean fracture • Contaminated fracture
Displacement • Non-displaced • Displaced • Translated, or
ad latus, with sideways displacement. • Angulated • Rotated • Shortened, a reduction in overall bone length when displaced fracture fragments overlap
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 – 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 – a fracture in which bone fragments separate completely. • Comminuted fracture – a fracture in which the bone has broken into several pieces.
Anatomical location An anatomical classification may begin with specifying the involved body part, such as the head or arm, followed by more specific localization. Fractures that have additional definition criteria than merely localization often may be classified as subtypes of fractures, such as a
Holstein-Lewis fracture being a subtype of a
humerus fracture. Most typical examples in an orthopaedic classification given in the previous section cannot be classified appropriately into any specific part of an anatomical classification, however, as they may apply to multiple anatomical fracture sites. •
Skull fracture •
Basilar skull fracture •
Blowout fracture – a fracture of the walls or floor of the
orbit •
Mandibular fracture •
Nasal fracture •
Le Fort fracture of skull – facial fractures involving the
maxillary bone and surrounding structures in a usually bilateral and either horizontal, pyramidal, or transverse way. •
Spinal fracture •
Cervical fracture • Fracture of
C1, including
Jefferson fracture • Fracture of
C2, including
Hangman's fracture •
Flexion teardrop fracture – a fracture of the anteroinferior aspect of a cervical vertebral •
Clay-shoveler fracture – fracture through the
spinous process of a
vertebra occurring at any of the lower cervical or upper thoracic vertebrae •
Burst fracture – in which a vertebra breaks from a high-energy axial load •
Compression fracture – a collapse of a vertebra, often in the form of
wedge fractures due to larger compression anteriorly •
Chance fracture – compression injury to the anterior portion of a vertebral body with concomitant distraction injury to the posterior elements •
Holdsworth fracture – an unstable fracture
dislocation of the
thoraco lumbar junction of the
spine •
Rib fracture •
Sternal fracture •
Shoulder fracture •
Clavicle fracture •
Scapular fracture •
Arm fracture •
Humerus fracture (fracture of upper arm) •
Supracondylar fracture •
Holstein-Lewis fracture – a fracture of the
distal third of the humerus resulting in
entrapment of the
radial nerve •
Forearm fracture •
Ulnar fracture •
Monteggia fracture – a fracture of the proximal third of the ulna with the dislocation of the
head of the radius •
Hume fracture – a fracture of the
olecranon with an associated
anterior dislocation of the
radial head •
Radius fracture •
Essex-Lopresti fracture – a fracture of the
radial head with concomitant dislocation of the
distal radio-ulnar joint with disruption of the
interosseous membrane •
Distal radius fracture •
Galeazzi fracture – a fracture of the radius with dislocation of the
distal radioulnar joint •
Colles' fracture – a distal fracture of the radius with dorsal (posterior) displacement of the wrist and hand •
Smith's fracture – a distal fracture of the radius with volar (ventral) displacement of the wrist and hand •
Barton's fracture – an
intra-articular fracture of the distal radius with dislocation of the
radiocarpal joint •
Hand fracture •
Scaphoid fracture •
Rolando fracture – a
comminuted intra-articular fracture through the base of the first
metacarpal bone •
Bennett's fracture – a fracture of the base of the
first metacarpal bone which extends into the
carpometacarpal (CMC) joint •
Boxer's fracture – a fracture at the neck of a
metacarpal •
Broken finger – a fracture of the carpal phalanges •
Pelvic fracture • Fracture of the
hip bone •
Duverney fracture – an isolated pelvic fracture involving only the
iliac wing •
Femoral fracture •
Hip fracture (anatomically a fracture of the
femur bone and not the
hip bone) •
Patella fracture •
Crus fracture •
Tibia fracture •
Pilon fracture •
Tibial plateau fracture •
Bumper fracture – a fracture of the
lateral tibial plateau caused by a forced
valgus applied to the
knee •
Segond fracture – an
avulsion fracture of the
lateral tibial condyle •
Gosselin fracture – a fractures of the tibial
plafond into anterior and posterior fragments •
Fibular fracture •
Maisonneuve fracture – a spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane •
Le Fort fracture of ankle – a vertical fracture of the
antero-
medial part of the
distal fibula with
avulsion of the
anterior tibiofibular ligament •
Bosworth fracture – a fracture with an associated fixed
posterior dislocation of the distal fibular fragment that becomes trapped behind the
posterior tibial tubercle; the injury is caused by severe
external rotation of the ankle •
Combined tibia and fibula fracture •
Trimalleolar fracture – involving the
lateral malleolus,
medial malleolus, and the distal posterior aspect of the tibia •
Bimalleolar fracture – involving the lateral
malleolus and the medial malleolus •
Pott's fracture •
Foot fracture •
Lisfranc fracture – in which one or all of the
metatarsals are displaced from the
tarsus •
Jones fracture – a fracture of the proximal end of the
fifth metatarsal •
March fracture – a fracture of the distal third of one of the metatarsals occurring because of recurrent stress •
Cuneiform fracture – a fracture of one of the three cuneiform bones typically due to direct blow, axial load, or avulsion •
Calcaneal fracture – a fracture of the calcaneus (heel bone) •
Broken toe – a fracture of the pedal phalanges
OTA/AO classification The Orthopaedic Trauma Association Committee for Coding and Classification published its classification system in 1996, adopting a similar system to the 1987
AO Foundation system. In 2007, they extended their system, unifying the two systems regarding wrist, hand, foot, and ankle fractures.
Classifications named after people Several classifications are named after the person (
eponymous) who developed it. • "Denis classification" for
spinal fractures • "
Frykman classification" for
forearm fractures (fractures of
radius and ulna) • "
Gustilo open fracture classification" • "Letournel and Judet Classification" for
Acetabular fractures • "Neer classification" for
humerus fractures •
Seinsheimer classification,
Evans-Jensen classification,
Pipkin classification, and
Garden classification for
hip fractures == Prevention ==