Abstract
The identification and proper management of fracture is a critical component of musculoskeletal care. This chapter provides an overview on fracture management, summarizing the basic principles of physical exam, imaging, and treatment. The chapter will also identify pearls and pitfalls to avoid in the care of these sometimes complex patients.
ICD-10-CM Codes
| S12 | Fractures to the neck |
| S22 | Fractures to the rib, sternum, and thoracic spine |
| S32 | Fracture of lumbar spine and pelvis |
| S42 | Fracture upper arm or shoulder |
| S52 | Fracture of forearm |
| S62 | Fracture of wrist, hand, finger |
| S72 | Fracture of femur |
| S82 | Fracture of lower leg, including ankle |
| S92 | Fracture of foot, toe (except ankle) |
Key Concepts
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A fracture represents a disruption of bone continuity, either complete or partial.
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Fractures are most commonly the result of trauma.
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They can be due to an abnormal force applied to a normal bone or a normal force applied to an abnormal bone.
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In patients without trauma, these injuries can be related to overuse, osteoporosis, or diseases related to abnormal bone formation.
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Fractures can result in gross or microscopic destruction of the bone matrix.
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Fractures that compromise neurovascular structures or have the potential to become open injuries must be emergently treated with immediate reduction of the fracture and/or dislocation.
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An open fracture is defined as one with a disruption of the skin overlying a fractured bone allowing contact with the external environment.
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A closed fracture has intact overlying skin.
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Lacerations or abrasions require evaluation for possible underlying open fracture and/or joint involvement, particularly those over bony prominences.
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Accurate fracture description is important for both proper diagnosis and treatment ( Table 12.1 ).
TABLE 12.1
Fracture Description
Fracture Descriptor
Type
Pathologic Description
Anatomic location
Epiphyseal
End of bone
Metaphyseal
Flared portion of bone between diaphysis and epiphysis
Diaphyseal
Shaft of long bone
Physeal (growth plate)
Salter-Harris classifications I–V describe fractures involving the growth plate
Orientation of fracture line
Transverse ( Fig. 12.1 )
Fracture perpendicular to long axis of bone
Oblique ( Fig. 12.2 )
Angular fracture down long axis of bone
Spiral ( Fig. 12.3 )
A complex fracture line that encircles shaft of bone (twisting fracture)
Longitudinal
Along long axis of bone
Segmental ( Fig. 12.4 )
Free-floating fracture segment bordered by fracture lines
Torus ( Fig. 12.5 )
Buckling of the cortex without breaking bone on other side (pediatric)
Greenstick ( Fig. 12.6 )
Fracture with disruption through one cortex while the other side remains intact (pediatric)
Pathologic
Fracture of bone with underlying disease
Fragments
Simple
2 fragments
Comminuted ( Fig. 12.7 )
>2 fragments
Avulsion ( Fig. 12.8 )
Fragment of bone torn away from the main mass of bone
Compression ( Fig. 12.9 )
Collapse of a bone, most often a vertebra
Position/displacement (described distal segment relative to proximal)
Nondisplaced
Fracture fragments are aligned
Displaced ( Fig. 12.10 )
Fracture fragments are separated
Nonangulated
Anatomic alignment preserved
Angulated ( Fig. 12.11 )
Fragments without usual anatomic alignment
Shortened (bayonette)
Described as the number of centimeters of overlap
Rotated
Description of distal fragment relative to proximal
