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1-45. CLASSIFICATION OF FRACTURES
a. A great amount of soft tissue damage often accompanies a fracture. A fracture that is associated with a large amount of nerve, blood vessel, and soft tissue damage is called a complicated fracture. A fracture without other damage would be referred to as an uncomplicated fracture. The nature and extent of the damage depends upon the type and direction of the force causing the fracture. The direction of the force that causes the injury will also determine the direction of the fracture line. The following terms describe the direction of the fracture line in relation to the bone's longitudinal axis.
(1) Linear. A fracture line that runs parallel to the bone's axis.
(2) Longitudinal. A fracture line that runs along the length of, but not parallel to, the bone's axis.
(3) Transverse. A fracture line that runs across, or at a right angle to, the bone's axis.
(4) Oblique. A fracture line that slants across the bone.
(5) Spiral. A fracture line that runs across the bone at an oblique angle and coils or spirals around the bone.
b. Fractures are primarily classified as open or closed.
(1) Open. An open, or compound fracture is one in which there is an open wound associated with the fracture site.
(2) Closed. In a closed, or simple fracture, there is no break in the skin associated with the fracture.
c. Fractures are further classified according to the condition of the bone, as described below.
(1) Complete. The bone is completely broken or split apart.
(2) Incomplete. The bone is not completely split and part of the bone remains intact.
(3) Displaced. The bone ends are separated at the fracture line and are completely out of alignment.
(4) Impacted or compressed. The bone ends are wedged or jammed into each other.
(5) Depressed. A piece of bone is driven inward, as in a skull fracture.
(6) Comminuted. The bone shatters or fragments into several pieces.
(7) Greenstick. An incomplete fracture in which the bone is partially broken and partially bent. It is similar in appearance to a piece of "green" wood when broken.
d. There are other classification terms associated with fractures, such as identifying a fracture by its location on the shaft of a bone (distal, midshaft, or proximal), or identifying fractures by the name of the physician who first identified them (Colles', Pott's, and so forth). Any of the classification terms may be used together to better describe a particular fracture. For example: An open, complicated, complete, comminuted fracture would be one in which the bone is completely broken and fragmented with an associated break in the skin and involvement of nerves, blood vessels, and soft tissue. Refer to figure 1-19 to study the illustrations of these classification terms.
