Fractures (main)

Describing Fractures[1]

A systematic approach for the description of fractures should be used to aid in clear communication with radiologists and consulting specialists.

  • Laterality
  • Open vs. Closed
  • Affected Bone
  • Location
    • Intra-articular vs. extra-articular
    • Portion of long-bone (proximal, middle, distal)
    • Anatomic site (ex. supracondylar, intertrochanteric, subtrochanteric, femoral neck)
  • Direction (orientation of fracture line relative to long-axis)
    • Transverse
    • Oblique
    • Spiral
    • Impacted
    • Torus / Greenstick (Peds)
  • Alignment
    • Displacement (distal relative to proximal fragment)
      • State in terms of direct measurement (e.g. 4mm) or %width of bones (50% displacement)
    • Angulation
      • Deviation from longitudinal axis, described in degrees and direction
      • Direction of apex of angle formed from redrawn longitudinal axes of fracture fragments
      • Valgus angulation is lateral
      • Varus angulation is medial
    • Rotation
      • Twisting around longitudinal axis (distal relative to proximal fragment)
      • Described as medial or lateral rotation (towards or away from midline respectively)
    • Separation
      • Distance two fragments have been pulled apart (but not offset from each other)
    • Shortening
      • Amount by which a bone's length has been reduced (expressed in mm or cm)
      • May occur by impaction or by overriding
    • Other
      • Incomplete: Only one side of cortex disrupted
      • Stress: Caused by repetitive low-force trauma/impact
      • Pathologic: Caused by trivial trauma or biomechanically routine force, suggestive of abnormal bone.
      • Fracture-Dislocation: Be careful not to describe these injuries as fractures with displacement
  • Fragmentation
    • Segmental (>2 fragments, with one segment not connected to either end)
    • Comminuted (>3 fragments)

Anatomic Terms

  • Diaphysis - shaft
  • Metaphysis - widened ends of the bones adjacent to the physis
  • Physis - radiolucent growth plate between metaphysis and epiphysis
  • Epiphysis - secondary ossification center at the end of the bones
  • Apophysis - secondary ossification center at site of tendon or ligament attachment

Head and Neck

Maxillofacial Trauma

Vertebral fractures and dislocations types

Upper Extremity

Humerus Fractures


Forearm Fractures

Carpal fractures

Hand and Finger Fractures





  • Thoracic and lumbar spine injuries

Lower Extremity

Proximal Leg

Distal Leg Fractures

Foot and Toe Fractures






General Fracture Management

See Also


  1. Wolfson, A. B., Cloutier, R. L., Hendey, G. W., Ling, L., & Schaider, J. (n.d.). Approach to Musculoskeletal Injuries. In Harwood-Nuss' clinical practice of emergency medicine (6th ed.). LWW.
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