Types of fractures by presence of complications
Depending on the condition of the skin and surrounding structures, fractures are divided into two main groups:
- Closed. In such injuries, skin integrity is not compromised, and bone fragments remain within the tissues.
- Complicated (including open). Accompanied by damage to the skin or mucous membranes, which creates a gateway for infection and the risk of inflammation. Complicated fractures also include injuries with damage to internal structures: major blood vessels, nerve trunks, joints (intra-articular fractures), as well as internal organs (brain, spinal cord, lungs, pelvic organs).
Mechanisms of injury and fracture line pattern
The shape of the fracture line directly depends on the direction and point of application of the traumatic force:
| Mechanism of injury | Type of fracture | Description |
|---|---|---|
| Direct impact | Transverse | The fracture line is perpendicular to the axis of the bone |
| Curvature | Oblique | The line runs at an angle to the bone (e.g., from a fall onto a fixed limb) |
| Torsion | Spiral (torsion) | Rotation of the torso with a fixed limb (like speed skaters on a curve) |
| Compression | Impacted | Sharp load along the long axis of the bone, one fragment drives into another |
| Avulsion | Avulsion fracture | A sudden muscle contraction or ligament tension detaches a bone fragment |
| Fragmentation | Comminuted | Formation of multiple fragments in high-energy trauma |
Fragment displacement (Dislocatio)
In fractures, bone fragments rarely remain in the correct position (with the exception of subperiosteal pediatric fractures). Displacement can be primary (due to the traumatic force itself or a fall) and secondary (due to subsequent muscle contraction or improper transport).
Main types of displacements:
- Axial / angular (ad angulum / ad axin). The bone axis is disrupted, fragments are set at an angle, which clinically manifests as limb curvature.
- Lateral / widthwise (ad latus). Fragments diverge laterally relative to the cross-section, causing segment thickening.
- Longitudinal (ad longitudinem). Can be with shortening (cum contractione), when fragments overlap each other, or with lengthening, when they diverge along the axis.
- Rotational / peripheral (periphericum / ad periferium). One of the fragments rotates around its longitudinal axis.
Features of open fractures
The severity of an open injury depends on where and how it was sustained:
- Industrial (working with machinery). The forearm, hands, and fingers are most frequently affected. Characterized by extensive lacerations, skin defects, tissue crushing, and vascular and nerve damage.
- Agricultural. Deep limb wounds with a high degree of contamination by manure or soil.
- Traffic and structural collapse. Lead to comminuted fractures with massive crushing of skin and muscles; tissues become soaked in blood and dirt.
The severity of the clinical course and the risk of infection directly depend on the scale of tissue damage. Lower limb fractures become infected more often than upper limb fractures due to a larger muscle mass and heavier skin contamination. Traffic and agricultural injuries are especially dangerous due to the risk of aerobic and anaerobic infection (e.g., tetanus or gas gangrene).
To remember the types of fragment displacement: Angle (ad axin), Side (ad latus), Length (ad longitudinem), Rotation (periphericum).
Class and exam questions
What is a greenstick fracture?
This is an incomplete subperiosteal fracture typical of children. In this type, the bone cracks, but the fragments are held together by the intact periosteum, so no displacement occurs.
Why does limb shortening occur in fractures?
Shortening occurs with longitudinal fragment displacement (cum contractione), when bone fragments overlap due to mechanical force or muscle pull.
What determines the severity of an open fracture?
On the scale of tissue damage: presence of bone fragmentation, extensive soft tissue crushing, as well as damage to major blood vessels and nerve trunks.
What else to study on this topic
- Mechanisms of secondary fragment displacement
- Prevention of aerobic and anaerobic infection in open fractures
- Clinical and diagnostic features of intra-articular fractures
- First aid principles to prevent secondary displacement
- Pathogenesis of comminuted and fragmented fractures
Master the entire topic in the "General Surgery" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on «Bone fractures» and another 3,335 pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 70 video lessons on the subject
Other topics in "CHAPTER 10. GENERAL ISSUES IN TRAUMATOLOGY"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.