Jeffrey R. Carlson, MD, CPE
In an earlier article by Dr. Joel Stewart, the ten types of bone fractures were listed, a description was given of each, and potential causes were given for many. Did you know that there are even more ways that fractures are classified clinically? These descriptors help physicians understand the physical presentation of the fractured bone within the body and how the fracture will need to be treated. They are as follows:
Closed fracture – this description simply means that the skin over the fracture is not open, and the bone is not protruding from the skin. A closed fracture is usually less severe than an open fracture as it presents much less risk of infection as there is no open wound to be contaminated. However, x-rays must be taken to visualize the type and severity of the break itself. They could reveal that the bone is shattered or displaced and will require surgery to reduce or repair.
Open or Compound fracture – this description means that the skin over the fracture is open, there is a wound, and bone or bone fragments could be sticking out of the wound. This type of fracture is typically the result of a high-energy accident or fall and the wound and bone may be exposed to dirt, grease, grass, glass, etc. An open fracture is always an emergency, and the patient is at high risk of infection due to wound contamination, tissue damage, and complications with healing and recovery. The patient will have to be taken to surgery for wound irrigation and decontamination, bone reduction and internal fixation with hardware to keep the bones in place as they heal.
Partial or Incomplete Fracture – this description is self-explanatory in that there isn’t a fracture all the way through the bone. Some clinicians include stress fractures in this definition; however, that description doesn’t typically fit the high force, unrepetitive nature of most of causes of these fractures.
Displaced Fracture – this descriptionlets us know that a gap has formed between the ends of the broken bones. This is important because bones that have displaced over a certain distance (measured in millimeters) will have to be reduced surgically. I will check that gap measurement on an x-ray of the broken bone. Is there a standard for the displacement gap length for all bones? No, there isn’t. Depending on their location in the body, the size of the bone and the surrounding muscles, tendons, and ligaments, one bone could have a displacement standard of no more than 2 mm, and another could have 5 mm, while another could be 3 ½ mm. That’s why orthopaedic surgeons must go to school for so long, so we can learn these things!
Stay tuned for more articles on orthopaedic topics and let us know if there is a condition or issue you’d like me or another OSC physician to address. We’ll be happy to do so!