Orthopaedics Orthopaedics · High Yield

Fracture Types

Fractures are classified by pattern (transverse, oblique, spiral, comminuted, segmental, impacted, greenstick, avulsion, pathological) to guide management and predict prognosis.

✦ The Mnemonic

"The Old Surgeon Carefully Avoided Giving Poor Seams"

Transverse · Oblique · Spiral · Comminuted · Avulsion · Greenstick · Pathological · Segmental

T Transverse Perpendicular to bone axis; direct force; inherently unstable

O Oblique Angled across bone; rotational or axial force; more stable than transverse

S Spiral Twisting force; often low-energy in elderly (fall); high-energy in young (sports)

C Comminuted More than 2 fragments; high-energy; difficult to fix; bone loss common

A Avulsion Tendon or ligament pulls off its bony attachment; common around knee, ankle, elbow

G Greenstick Incomplete fracture through one cortex; children only — bone is more flexible

P Pathological Through diseased bone; minimal force; tumour, metastasis, osteoporosis, Paget's disease

S Segmental Two fracture lines creating an isolated 'floating' segment; high energy

📚 Clinical Breakdown

Open (compound) fracture Gustilo-Anderson classification: Grade I (<1 cm wound, minimal contamination), Grade II (1–10 cm, moderate), Grade III (>10 cm or highly contaminated — IIIA: adequate coverage; IIIB: needs flap; IIIC: vascular injury). Higher grades = higher infection and amputation risk.

Stress fractures are fatigue fractures from repetitive submaximal loading — the bone's remodelling response is overwhelmed. Common in military recruits (metatarsals — 'march fractures'), runners (tibia, femoral neck), and dancers (2nd metatarsal). They may be invisible on plain X-ray — MRI is the most sensitive investigation.

Salter-Harris classification for paediatric physeal (growth plate) injuries: I (physis only), II (physis + metaphysis — most common), III (physis + epiphysis), IV (through physis, epiphysis, and metaphysis), V (crush injury to physis — worst prognosis). Injuries involving the physis risk growth disturbance.

Most common fracture type Transverse (direct trauma)

Children's fracture Greenstick — incomplete

Pathological fracture hint Fracture with minimal trauma — check for underlying disease

Growth plate injury Salter-Harris classification

⭐ Clinical Pearl

Displaced femoral neck fracture in a young patient: orthopaedic emergency — internal fixation within 6–12 hours to reduce AVN risk. In the elderly (>65): total hip replacement (THA) for displaced femoral neck fractures — better functional outcomes than internal fixation in this cohort. Garden classification guides decision-making.

Next: Bone Healing Stages →