Bone Fracture Types Explained: Patterns, Diagnosis, and Management

Bone fractures are a common musculoskeletal injury affecting individuals of all ages. Proper classification of the different types of fractures is important as it guides diagnosis, management, and rehabilitation strategies. This also helps physiotherapists in the assessment process and plan effective care.

In this article, we will learn about various types of fractures, their clinical significance.

What Is a Fracture? – Definition and Overview

Definition: A break and breach in the continuity of bone is called a fracture. A fracture disrupts continuity and breaks the bone. For example, you can see a broken bone – is there continuity, has it broken, or is there a breach? This is what we call a fracture.

Based on different criteria, we can classify fractures into different types. We can classify based on these criteria:

1. Types of fracture based on communication with the exterior.
2. Fracture types are based on the pattern of fracture.
3. Classification based on completeness of fracture.

So, let us start with types based on communication with the exterior

Type of bone fracture based on communication with the exterior.

Based on communication with the outside, a fracture can be:

1. Simple (Closed) Fracture: This occurs internally. For example, sometimes we fracture our wrists, the fracture is inside, and nothing is visible on the skin.
2. Compound (Open) Fracture: Also called a compound fracture because when it fractures, there is some kind of cut in the skin, making the fracture visible. The bone can break and tear through the skin, coming outwards. This is a compound fracture.

Closed fractures usually occur in fractures caused by low-impact force. For example, when we fall (like slipping in the bathroom), twist, direct blows during sports like football, basketball. It can also happen in low-impact minor accidents, such as bumping into furniture.

An open fracture is usually seen in high-impact road traffic accidents involving cars, motorcycles, resulting in severe trauma that breaks the bone and pierces the skin. It can also happen in industrial or workplace injuries.

In a closed fracture, the fractured bone remains inside, and the skin shows no injury. In compound (open) fractures, the bone pierces through and comes out of the skin.

Gustilo Classification (for Open Fractures)

Open fractures can be classified using the Gustilo classification:

• Type 1: The wound is less than 1 cm.
• Type 2: The wound is about 1 to 5 cm deep and wide.
• Type 3: Extensive bone laceration. The skin and tissue covering the bone must have burst; the bone covering is stripped and cut from there, with all tissue cut away. This means the fracture is clearly visible, the skin is torn apart, and the bone is completely visible.

Type 3 can be divided into three further types:

• One where the bone can be covered with soft tissue — a flap of skin or muscle that is surgically removed can cover it.
• Another is where the bone cannot be covered with soft tissue due to extreme skin loss. In this case, muscle or skin grafts are needed to cover the area through plastic surgery.
• The third may involve neurological deficits, meaning nerve damage or even paralysis.

Classification of bone fractures based on pattern:

When a bone is fractured, due to the impact of external force, the fracture happens in a different pattern and shape. So, based on this, the fracture can also be divided into six different types.

1. Transverse Fracture: The fracture is perpendicular to the bone, forming a 90-degree angle.
2. Oblique Fracture: The fracture is slanted along the length of the bone.
3. Spiral Fracture: The fracture is oblique but twisted.
4. Comminuted Fracture: The bone shatters into multiple pieces, commonly seen in traffic accidents or when a heavy object falls on a limb.
5. Segmental Fracture: The bone is fractured into segments with maintained circumference, unlike a comminuted fracture, which breaks the circumference into separate pieces.
6. Floating Segment: A type of comminuted fracture where broken bone fragments float between the fracture sites.

Fracture type based on its completeness:

Bone fracture is also classified based on whether the fracture is complete or incomplete.

• Complete Fracture: The break separates the bone into two distinct segments completely.
• Incomplete Fracture: The bone is cracked but not entirely separated into segments.

Example of incomplete fractures is stress fracture and greenstick fractures.

Stress fracture: Seen in sports personalities regularly performing the same exercise, stress accumulates and gradually develops a crack; this is a stress fracture.

Greenstick fracture: This occurs in children. It’s called “greenstick” because, like a fresh twig, it cracks but does not break completely due to flexible cartilage that has not fully converted to bone. Hence, children’s bones may have incomplete, greenstick fractures.

Clinical features (Symptoms and Signs):

• Symptoms include pain, swelling, and restriction of movement. These are reported by the patient.
• Signs include tenderness (pain to touch), crepitus (crackling sound with movement, not always present), and movement restriction.

Investigation: The main diagnostic tool is X-ray:

The choice of investigation for a fracture is X-ray. Two views are required, Anterior-posterior (AP View) and lateral view, which help to diagnose the location and displacement of the fracture.

• AP view detects the lateral or medial displacement of the fracture segment.
• The lateral view detects anterior or posterior displacement of the fracture.

Treatment of bone fractures

Conservative treatment (non-surgical):

Plastering (POP cast or crepe bandages) for immobilization if the fracture is not much displaced.

Closed reduction done under anaesthesia. For closed reduction, first traction is given, and the fracture segment is aligned, and then plastering is done.

Example: For a displaced wrist fracture, the surgeon may give anaesthesia, apply traction to set the displacement, and apply plaster.

Surgical treatment:

Needed if the fracture segments are far apart or in open fractures. Surgery may involve:

1. Internal fixation (screws and plates to stabilise the fracture inside the body).
2. External fixation (external fixator devices). Used in compound fractures using external fixator devices such as tubular fixator and ring fixator.

Elizarov technique: Named after Russian surgeon Elizarov, this is an external fixator used for certain fractures.

FAQ on Bone Fracture Classification

Sunit. S. Ekka

The author is a physiotherapist who has been practising for the last 17 years. He holds a Bachelor's in Physiotherapy (BPT) from SVNIRTAR (Swami Vivekananda National Institute of Rehabilitation and Research), one of the prestigious physiotherapy schools in India.

Whatever he learns dealing with his patient, he shares it with the world through blogs and e-books. He also owns a YouTube channel, "Sunit Physiotherapist" with over 8 lakh active subscribers. Here, he shares everything he gets to learn serving the patient.