Types Of Fractures

A fracture is a break in a bone. There are many different types. Acute fractures are caused by a direct impact, such as a fall or a severe tackle. Stress fractures develop over time and are caused by overuse. Here we explain the common types of bone fracture in sport.

Acute fractures

  • Acute fractures occur suddenly from direct trauma, fall or violent twisting movement. They are more common in contact sports, skiing and motor racing.
  • Symptoms include severe pain at the time of the injury, tenderness and rapid swelling. Bruising may develop and in displaced injuries, there may be visible deformity.

Stress fractures

  • A stress fracture is caused by repetitive stress from overuse. They occur gradually over time beginning with a ‘stress reaction’ of the bone.
  • This then progesses to a stress fracture and eventually, if ignored can develop into an acute fracture.

Read more on stress fractures.


Common acute fractures in sport

  • Metatarsal fractures – occur to the long bones in the foot.
  • Calcaneal fracture – this is break of the calcaneus (heel bone). It is not a common injury, but may occur when landing badly from a height.
  • Jones fracture – is a fracture of the 5th metatarsal bone on the outside of the foot. It is caused either by overuse, or following an ankle sprain

Leg & ankle

  • Broken ankle (Pott’s fracture) – any of the bones in the ankle can be broken. A Pott’s fracture is one of the more common.
  • Ankle avulsion – where a ligament tears, pulling a piece of bone with it. This occurs from a sprained ankle and may often be missed initially.
  • Broken leg – the tibia and fibula bones in the lower leg are more commonly broken than a break of the femur bone.
  • Femur fracture – is a break of the femur (thigh bone).
  • Biceps femoris avulsion – occurs when the tendon comes away from the bone at the outside back of the knee.
  • Tibial plateau – is a break of the upper surface of the tibia (shin) bone.

Pelvis

  • Pelvic avulsion fracture – most commonly occurs at the ischial tuberosity where the hamstrings attach at the back of the leg.

Shoulder, arm & elbow

  • Broken arm – can include breaks to the radius and ulna in the forearm.
  • Humerus fracture – is a break of the humerus bone in the upper arm.
  • Broken elbow – can involve any of the arm bones.
  • Olecranon fracture – occurs at the prominant bony protrusion at the back of the elbow.
  • Broken collar bone – also known as a clavicle fracture is a common sports injury.
  • Elbow avulsion fracture – occurs when a tendon or ligament tears, pulling a small fragment of bone away with it. It is more common in children, occuring on the inside of the elbow.

Wrist

  • Broken wrist – any of the carpal bones in the wrist may be fractured, often from falling onto an outstretched arm.
  • Colles fracture – is a break at the wrist end of the radius bone in the forearm.
  • Scaphoid fracture – is one of the more common injuries that should not be missed.
  • Hook of hamate – this is a fracture of the hamate bone on the little finger side of the wrist.
  • Triquetrium fracture – is a break of the Triquetral bone (sometimes called triquetrum).
  • Bennett’s fracture – is an injury to the base of the thumb joint.
  • Rolando fracture – is similar to a bennett’s fracture, but is more complex. The bone breaks into multiple fragments.
  • Smith’s fracture – is a break at the end of the radius bone. The fragment of fractured bone is displaced forwards to the palm side of the wrist.

Hand & fingers

  • Metacarpal fracture – or broken hand is a break of any of the long metacarpal bones in the hand.
  • Boxer’s fracture – is a break to either the 4th or the 5th Metacarpals which are the long bones on the outside of the hand.
  • Broken finger – involves any of the phalanges (finger) bones.
  • Broken thumb – is either a break at the base of the thumb or the phalanges.

Back & chest

Head

  • Skull fracture – is a break to one of the bones which form the head.

Open fractures & closed fractures

  • A closed fracture is also called a simple fracture. This is a break of the bone where the skin surface remains intact.
  • An open fracture is also known as a compound fracture. It occurs when the end of the bone breaks the surface of the skin. As a result, this type of fracture is susceptible to infection.

Other types of acute bone fracture

After closed and open types, fractures are further classified depending on how the bone is broken, number of fragments and displacement.

Types of bone fracture
  • Transverse – a straight line.
  • Oblique – an oblique (or diagonal).
  • Spiral – which spirals around the bone.
  • Comminuted – where the bone breaks into more than one piece.
  • Avulsion – this is where a ligament or tendon tears, pulling a small piece of bone away with it.
  • Greenstick fractures – these occur in young athletes. This is because their skeletons have not fully grown or hardened. As a result the immature skeleton is more ‘bendy’ than an adults skeleton. Therefore when a bending force is applied to the bone it compresses on the inside and is stretched on the outside. The bone partially fractures in the same way that a live tree branch would break. Hence the name ‘greenstick’.

Growth plate fractures in children

The growth plate is the area at the end of a bone where new growth occurs. It is a weak point which has not fully hardened as it has in an adult skeleton. Often growth plate areas are points where tendons attach to bone. In particular, this makes the young athlete susceptible to avulsion fractures.


Complications of fractures

A complication is a problem or condition which is caused by, or follows on from a broken bone.

Infection

Fractures are most at risk of complications if they are open or displaced. In particular, they are at risk of developing an infection. If the skin is broken then foriegn bodies and bacteria can enter. As a precaution, they are often treated with antibiotics.

Soft tissue damage

There is always the possibility of associated soft tissue damage to nearby muscles, tendons, ligaments, nerves, bursae and blood vessels. These are often more troublesome in the long-term than the broken bone itself.

Deep vein thrombosis

Deep vein thrombosis (DVT) is a risk factor of lower limb fractures especially. The chances of this can be reduced through active muscle contractions whilst in a plaster cast to maintain blood circulation.

Muscle atrophy

Muscle wasting is an unavoidable side-effect. This is because the muscles surrounding the bone are barely used for the entire period of casting. Again, active muscle contractions can help to limit this to an extent.


How are fractures treated?

Treatment will depend on the type and severity of the fracture. However, in general:

  • Any suspected fracture should first of all be X-rayed to confirm the diagnosis and identify type and severity.
  • If they are not displaced or are only minimally displaced then a cast is usually applied to immobilize the limb. A period of 4-8 weeks, is usually enough time to allow healing.
  • Displaced fractures will need to be ‘reduced’. This means put back into alignment. In some cases, they may require surgical stabilization.
  • Following the period of immobilization, once given the all-clear by the doctor or surgeon involved, a rehabilitation program should be implemented which focuses on regaining full movement and strength to the limb.
This article has been written with reference to the bibliography.

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