William Herring, M.D.

© 2003

Recognizing
Fractures
(and describing them)

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Many fracture examples are part of Radiology Resource and Review (R3) ©2001 Medical College of Georgia
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Definitions

 Fracture
 Dislocation
 Subluxation
 Fracture

 A disruption in all or
part of the cortex
of a bone
 All = complete
 Part = incomplete =
children

Complete fracture of the surgical

neck of the humerus
 Dislocation

 The bony components

of a joint no longer are
in contact with each
other
 There is complete
disruption of the joint

R3
Dislocation of the metacarpal-
phalyngeal joint of the thumb
 Subluxation

 The bony
components of a
joint are partially in
contact with each
other
 There is partial
disruption of the
joint
R3
Incomplete Fractures

 Greenstick –
fracture
through one
cortex
 Torus –
buckling of
the cortex
 Also called “Buckle fx”
Greenstick Fractures Buckle Fractures
How Fractures Are Described

 By the direction of the fracture line

 By the relationship of the fragments
 By the number of fragments
 By communication with the atmosphere
How Fractures Are Described
 By the direction of the fracture line
 Transverse
 Diagonal or oblique
 Longitudinal
 Spiral
 How Fractures Are Described

 By the direction of the

fracture line
 Transverse –
perpendicular to the
long axis of the bone
 Caused by a force
perpendicular to shaft
 How Fractures Are Described

 By the direction of the

fracture line
 Diagonal or oblique –
caused by a force
usually applied in the
same direction as the
long axis of the bone
 How Fractures Are Described

 By the direction of the

fracture line
 Longitudinal – along the
long axis of the bone

R3
How Fractures Are Described

 By the direction of the

fracture line
 Spiral – a twisting
fracture caused by a
torque injury such as
planting the foot in a
hole while running
How Fractures Are Described

 By the relationship of one fracture

fragment to another
 Displacement
 Angulation
 Shortening
 Rotation
 Most fractures display more than one of
these abnormalities of position
How Fractures Are Described

 By convention, abnormalities of position

describe the relationship of the distal
fracture fragment relative to the proximal
fragment
Displacement

 The amount of off-set of

the distal fracture
fragment relative to the
proximal
 There is lateral
displacement of the
distal femoral fracture
fragment in this case Lateral Medial
Angulation

 The angle away from

the normal that the
distal fragment makes
with the proximal
 In this case the distal
fragment is angulated
medially from the
position it would have
Medial Lateral
were it not fractured
 Shortening

 Overlapping of the
ends of the fracture
fragments
 Shortening is usually
described by the
number of centimeters
of overlap
There is also medial displacement here Medial Lateral
 Rotation

Anteroposterior
 Almost always involves at knee

long bones (humerus

and femur)
 Knee joint is in AP
position (points forward)
but ankle points lateral,
in this case
Lateral at
ankle
 How Fractures Are Described

 By the number of
fracture fragments 1

 Two fragments - 2

Simple 1
3

 More than two

4
fragments - 2
Comminuted

Simple Comminuted
 How Fractures Are Described

 By the relationship of
the fracture to the
atmosphere
 Closed
 Open or compound
 Best evaluated
clinically

Open or compound fracture of the tibia

communicates with outside air
Salter-Harris Fractures

 Fractures that involve the epiphyseal

plate alone or in combination with an
adjacent part of the bone
 Why is the classification important?
 Prognostic value
 Type I’s and II’s do well
 Type IV’s and V’s can develop early fusion
of epiphysis and shortening of that bone
 Salter-Harris Classification

 Type I – Epiphyseal plate alone

 Type II – Epiphyseal plate and metaphysis
 Type III – Epiphyseal plate and epiphysis
 Type IV – Epiphyseal plate, metaphysis
and epiphysis
 Type V – crush fracture of epiphyseal plate
 Salter-Harris Classification

 Type I –
Fracture through
the epiphyseal
plate alone
 Often difficult to
detect without
other side for
comparison
R3
Salter-Harris Classification

 Type II – fracture of the

metaphysis and the
epiphyseal plate
 Most common type of
Salter fracture
 “Corner-sign” – small
metaphyseal fragment
R3
Salter-Harris Classification

Type III – Fracture

of the epiphyseal
plate and the
epiphysis

R3
Salter-Harris Classification

 Type IV – Fracture
through the
metaphysis,
epiphyseal plate
and the epiphysis
 Poorer prognosis –
i.e. premature
closure of epiphysis
R3
Common Fracture Eponyms

 Colle’s fracture
 Smith’s fracture
 Jones’ fracture
 Boxer’s fracture
 Common Fracture Eponyms

 Colle’s
fracture –
fracture of
the distal
radius with
dorsal
angulation

R3
Common Fracture Eponyms

 Smith’s fracture –
fracture of the
distal radius with
palmar
angulation
 Fall on a flexed
hand
R3
 Common Fracture Eponyms

 Jones’ fracture – fx base 5th metatarsal

 Common Fracture Eponyms

 Boxer’s fracture – fx
head 5th metacarpal
with palmar
angulation
 Most often the result
of punching a
person or wall

R3
Easily Missed Fractures

 Scaphoid fractures
 Buckle fractures of radius/ulna
 Radial head fracture
 Supracondylar fractures in children
 Posterior dislocation of the shoulder
 Hip fractures
 Easily Missed Fractures

 Scaphoid
fractures –
common
 Pain in anatomical
snuff box
 Fall on
outstretched hand
 Can lead to R3

avascular
necrosis
 Easily Missed Fractures

 Buckle fractures of
radius/ulna
 Children
 Look for angulation of
cortex
 Heal quickly

R3
 Easily Missed Fractures

 Radial head
fracture
 Common
 May require
multiple views
to see it
 Easily Missed Fractures

 Supracondylar
fractures in
children

R3
Supracondylar fractures can be difficult
– especially in children (this is an adult)
 Easily Missed Fractures

 Posterior
dislocation of the
shoulder
 Humeral head
looks like
“lightbulb”
 Usually need
another view like
axillary or Y view R3
 Easily Missed Fractures

 Hip fractures
 May be very
subtle and
require bone
scan or MRI for
diagnosis
 In this case,
white zone of
sclerosis is an R3

impacted
 Easily Missed Fractures

 Jones’ fracture –
fracture of the base
of the 5th metatarsal
 Avulsion type
fracture frequently
caused by pull of
peroneus brevis
tendon
Fracture Healing

 Indistinctness of fracture line

 Bony callous production
 Bridging of fracture
 Obliteration of fracture line
 Remodeling of bone
 R3
Series of images shows indistinctness of fracture line with bony callous
formation and, finally, obliteration of the fracture line. There are metallic rods
transfixing the fracture.
 Quiz
Correct answers on following slides in red
The two terms below that
best describe the
position of these femoral
fracture fragments are:
1. Angulated
2. Comminuted
3. Displaced
4. Shortened
5. Rotated

Answer follows ►
 The two terms below that
best describe the
position of these femoral
fracture fragments are:
1. Angulated
2. Comminuted
3. Displaced
4. Shortened
5. Rotated

There is also a fracture of the patella

The terms below that best
describe this fracture
are:
1. Angulated
2. Comminuted
3. Rotated
4. Greenstick
5. Spiral

Answer follows ►
The terms below that best
describe this fracture
are:
1. Angulated
2. Comminuted
3. Rotated
4. Greenstick
5. Spiral
This is an example of a:
1. Comminuted fracture
2. Dislocation
3. Displaced fracture
4. Subluxation

Answer follows ►
 This is an example of a:
1. Comminuted fracture
2. Dislocation
3. Displaced fracture
4. Subluxation

Posterior dislocation of the hip

This fracture most likely
occurred:
1. An hour ago
2. A day ago
3. A week ago
4. A decade ago

Answer follows ►
 This fracture most likely
occurred:
1. An hour ago
2. A day ago
3. A week ago
4. A decade ago

Healing “stress-type” fracture of the 3rd

metatarsal already has significant
callous formation indicating it is at
least several days old
This is an example of a
Salter-Harris:
1. Type I fracture
2. Type II fracture
3. Type III fracture
4. Type IV fracture

Answer follows ►
 This is an example of a
Salter-Harris:
1. Type I fracture
2. Type II fracture
3. Type III fracture
4. Type IV fracture

There is a fracture that extends through

the epiphysis but not the metaphysis.
There is also a fracture of the
epiphyseal plate.
Congratulations, You Graduate

I know my
Fractures

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