Fracture & Its Types
Fracture: A break in the continuity of bone/cartilage or
both
Etiology: Fractures of long bones result from forces
applied to them
a. Compressive forces: Applied axially result in oblique
fractures
b. Bending forces: Transverse crack on tensile side and
oblique fracture / butterfly fragment on
compressive side
c. Torsional forces: Spiral fractures
d. Tensile forces: Transverse fractures / Avulsion fracture
Classification:
On the basis of
1. Presence or absence of a communicating
wound.
2. Extent of damage to the bone and the
surrounding soft tissues.
3. The direction of the fracture line.
4. The position of the fracture fragments
5. Site of the fracture.
Classification (cont)
On the basis of presence or absence of a
communicating wound, the fracture may be
• Closed Fracture; in which the bone breaks but the skin
remains intact. Hence, there is no communication
between the fracture site and the outside environment.
• Open Fracture; where there is also a break in the
continuity of the overlying skin and underlying soft
tissue leading into or communicating with the fracture
and its hematoma; thereby exposing the fracture site to
the external environment.
Open Fractures Classification
• Type I Small laceration (< 1 cm) Clean
• Type II Larger laceration (> 1 cm) Mild soft-
tissue trauma, no flaps or avulsions
• Type III(a) Vast soft-tissue laceration or flaps or
high-energy trauma, Soft tissue available for wound
coverage
• Type III(b) Extensive soft-tissue injury loss, Bone
exposure present, Periosteum stripped away from
bone
• Type III(c) Arterial supply to the distal limb damaged,
arterial repair required for limb salvage
• Type IV Involving amputation of limb. Severe soft
tissue damage and neurovascular injury
Classification (cont)
On the basis of extent of damage to the bone and the surrounding soft
tissues, the fracture may be
• Single Fracture; When the bone breaks into two pieces only.
• Multiple or Segmental Fracture; Where the bone breaks into more than two
pieces, but the fracture lines do not communicate with each other.
• Comminuted / multifragmentary or Complex Fracture; in which the bone breaks
into more than two pieces, the fracture lines communicate with one another and
meet at a common point.
• Complicated Fracture; when some important structure like main nerve or blood
vessel in the vicinity of the fracture site also gets damaged.
• Impacted Fracture; when one segment of the fracture gets impacted in the other
or the bone fragments are driven firmly together.
• Wedge fracture; which is a multifragmental fracture with some contact between
the main fragments after reduction. In such fractures, length and alignment of the
bone is normally restored after reduction.
Classification (cont)
On the basis of direction of the fracture line, the fracture may be
• Transverse Fracture; when the fracture line runs straight across
the bone or almost at right angles to the long axis of the bone.
• Oblique Fracture; when the fracture line is at an oblique angle to
the long axis of the bone. This fracture may be further classified
as long oblique or short oblique. In long oblique fracture, the
length of the fracture line is more than twice the diameter of the
bone; whereas it is less than that in short oblique fracture.
• Spiral Fracture; when the fracture line is not straight, rather it is
at a twisted angle as if encircling the shaft of the bone in a spiral
fashion as is usually seen in fractures going through the
musculospiral groove of the humerus.
Classification (cont)
On the basis of the position of the fracture fragments, the
fracture may be
• Over-riding Fracture; when the distal fracture fragment over
rides the proximal one. It is normally seen in distal shaft femoral
fractures where the distal fracture fragment is pulled caudo-
proximally due to the pull of the semimembranosus muscle.
• Distracted Fracture; in which the distal fracture fragment is
pulled away from the proximal fragment in any direction, but in
the same plane.
• Avulsion Fracture; when a fragment of bone, which is the site of
insertion of a muscle, tendon or ligament, is detached from the
main bone as a result of a forceful pull.
Supracondylar Fracture of Femur
Avulsion Fracture
Of Tuber-Calsis
Classification (cont)
On the basis of site of the fracture, the fracture may be
• Proximal and Distal Segment Fracture;
• Type A (Extra-articular); when the articular surface is not
fractured but is separated from the diaphysis. These are
typically called metaphyseal fractures such as Supracondylar
Fracture which is normally of transverse type, occurs just above
the condyles and does not disrupt the articular surface of the
bone.
• Type B (Partial articular); when only part of the joint surface is
involved, with the remaining portion still attached to the
diaphysis. Unicondylar fractures are the most common
examples when the fracture line partially passes through the
articular surface.
Classification (cont)
• Type C; in which the joint surface is
fractured and is completely detached from the
diaphysis. Humeral ‘T’ or ‘Y’ fractures are
representatives of this type when there is
complete disruption of the articular surface from
the diaphysis.
• Diaphyseal Fracture; when the fracture occurs
in the diaphyseal region of the bone. The
bone healing in this region usually takes more
time due to its compactness.
Y & T Fractures
Classification (cont)
Physial Fractures: Salter-Harris Classification
a. Type-I: through the physis
b. Type-II: through the physis & a portion of metaphysis
c. Type-III: through the physis & a portion of epiphysis (articular
fractures)
d. Type-IV: through epiphysis, crosses physis & through the
metaphysis (articular fractures)
e. Type-V: Crushing injuries of physis; not visible radiographically,
become evident when physeal function ceases.
f. Type-VI: A variant of type V; trauma to the physis results in
some bridging of new bone across one side of growth plate
(resulting in cessation of growth in that area & an angular or
rotational deformity.
Salter-Harris Classification
Symptoms:
Even though they are not always readily detectable, visible signs
at the fracture area include one or more of the following:
• 1. Pain or localized tenderness
• 2. Deformity or change in angulations
• 3. Abnormal mobility
• 4. Local swelling (This may appear almost immediately or not
until several hours or a day after the accident. It usually
persists for 7 to 10 days because of the disturbed flow of
blood and lymph.)
• 5. Loss of function
• 6. Crepitus
Diagnosis:
Diagnosis of the fracture is based upon
1. History:
2. clinical examination: should also include evaluation of
the regional nerve
3. Symptoms:
4. radiographic / fluoroscopic examination: Radiographs
of at least two orthogonal (90 degrees to each other)
views are essential for proper evaluation of the
fracture type, accurate diagnosis and selection of the
best procedure for reduction and immobilization.
Prognosis:
Prognosis of a fracture depends upon
1. The type and location of the fracture
2. The size and weight of the animal
3. Accuracy of reduction and immobilization of
the fracture.
In general; the simple the fracture, the better is
the prognosis.
