Editing Bone fracture (section)

==Diagnosis==
[[File:Xraymachine.JPG|thumb|[[Medical radiography|Radiography]] to identify possible fractures after a knee injury]]
A bone fracture may be diagnosed based on the history given and the physical examination performed. [[Medical radiography|Radiographic imaging]] often is performed to confirm the diagnosis. Under certain circumstances, radiographic examination of the nearby joints is indicated in order to exclude dislocations and fracture-dislocations. In situations where projectional radiography alone is insufficient, [[Computed Tomography|Computed Tomography (CT)]] or [[Magnetic Resonance Imaging|Magnetic Resonance Imaging (MRI)]] may be indicated.{{cn|date=June 2021}}

===Classification===
{{Redirect|Compound Fracture|the 2013 horror film|Compound Fracture (film)}}
[[File:612 Types of Fractures.jpg|thumb|Compare healthy bone with different types of fractures: <br>&nbsp;&nbsp;&nbsp;(a) closed fracture <br>&nbsp;&nbsp;&nbsp;(b) open fracture <br>&nbsp;&nbsp;&nbsp;(c) transverse fracture <br>&nbsp;&nbsp;&nbsp;(d) spiral fracture <br>&nbsp;&nbsp;&nbsp;(e) comminuted fracture <br>&nbsp;&nbsp;&nbsp;(f) impacted fracture <br>&nbsp;&nbsp;&nbsp;(g) greenstick fracture <br>&nbsp;&nbsp;&nbsp;(h) oblique fracture]]

[[File:Offene Luxation.jpg|thumb|200px|Open ankle fracture with luxation]]
[[File: Periprosthetic fracture of left femur, case 1, before treatment.jpg|thumb|200px|Periprosthetic fracture of left femur]]
In [[Orthopedic surgery|orthopedic]] [[medicine]], fractures are classified in various ways. Historically they are named after the physician who first described the fracture conditions, however, there are more systematic classifications as well.{{cn|date=June 2021}}

They may be divided into stable versus unstable depending on the likelihood that they may shift further.{{cn|date=June 2021}}

====Mechanism====
* [[Trauma (medicine)|Traumatic]] fracture – a fracture due to sustained trauma. e.g., fractures caused by a fall, [[Traffic collision|road traffic accident]], fight, etc.
* [[Pathologic fracture]] – a fracture through a bone that has been made weak by some underlying disease is called pathological fracture. e.g., a fracture through a bone weakened by [[metastasis]]. [[Osteoporosis]] is the most common cause of pathological fracture.
* [[Periprosthetic]] fracture – a fracture at the point of mechanical weakness at the end of an [[Implant (medicine)|implant]].

====Soft-tissue involvement====
* Closed/simple fractures are those in which the overlying skin is intact<ref>{{Cite web|title=Simple fracture {{!}} pathology|url=https://www.britannica.com/science/simple-fracture|access-date=2021-05-19|website=Encyclopedia Britannica|language=en|archive-date=19 May 2021|archive-url=https://web.archive.org/web/20210519172848/https://www.britannica.com/science/simple-fracture|url-status=live}}</ref>
* [[Open fracture|Open/compound fractures]] involve wounds that communicate with the fracture, or where fracture [[hematoma]] is exposed, and may thus expose bone to [[contamination]]. Open injuries carry a higher risk of [[infection]]. Reports indicate an incidence of infection after internal fixation of closed fracture of 1-2%, rising to 30% in open fractures.<ref>{{cite journal |last1=Metsemakers |first1=WJ |last2=Onsea |first2=J |last3=Neutjens |first3=E |last4=Steffens |first4=E |last5=Schuermans |first5=A |last6=McNally |first6=M |last7=Nijs |first7=S |title=Prevention of fracture-related infection: a multidisciplinary care package. |journal=International Orthopaedics |date=December 2017 |volume=41 |issue=12 |pages=2457–2469 |doi=10.1007/s00264-017-3607-y |pmid=28831576|s2cid=12894601 |doi-access=free }}</ref>
** Clean fracture
** Contaminated fracture

====Displacement====
* Non-displaced
* Displaced
** Translated, or ''ad latus'', with sideways displacement.<ref>{{cite web|url=https://radiopaedia.org/articles/fractures-of-the-extremities-general-rules-and-nomenclature-1|title=Fractures of the extremities (general rules and nomenclature)|website=[[Radiopaedia]]|author=Roberto Schubert|access-date=2018-02-21|archive-date=13 May 2021|archive-url=https://web.archive.org/web/20210513070414/https://radiopaedia.org/articles/fractures-of-the-extremities-general-rules-and-nomenclature-1|url-status=live}}</ref>
** Angulated
** Rotated
** Shortened, a reduction in overall bone length when displaced fracture fragments overlap

====Fracture pattern====
{{main|List of fracture patterns}}
* Linear fracture – a fracture that is parallel to the bone's long axis
* Transverse fracture – a fracture that is at a right angle to the bone's long axis
* Oblique fracture – a fracture that is diagonal to a bone's long axis (more than 30°)
* [[Spiral fracture]] – a fracture where at least one part of the bone has been twisted
* [[Compression fracture]]/[[wedge fracture]] – usually occurs in the vertebrae, for example when the front portion of a [[vertebra]] in the spine collapses due to [[osteoporosis]] (a medical condition which causes bones to become brittle and susceptible to fracture, with or without trauma)
* Impacted fracture – a fracture caused when bone fragments are driven into each other
* [[Avulsion fracture]] – a fracture where a fragment of bone is separated from the main mass

====Fragments====
* Incomplete fracture – a fracture in which the bone fragments are still partially joined, in such cases, there is a crack in the osseous tissue that does not completely traverse the width of the bone.
* Complete fracture – a fracture in which bone fragments separate completely.
* Comminuted fracture – a fracture in which the bone has broken into several pieces.

====Anatomical location====
An anatomical classification may begin with specifying the involved body part, such as the head or arm, followed by more specific localization. Fractures that have additional definition criteria than merely localization often may be classified as subtypes of fractures, such as a [[Holstein-Lewis fracture]] being a subtype of a [[humerus fracture]]. Most typical examples in an orthopaedic classification given in the previous section cannot be classified appropriately into any specific part of an anatomical classification, however, as they may apply to multiple anatomical fracture sites.
* [[Skull fracture]]
** [[Basilar skull fracture]]
** [[Blowout fracture]] – a fracture of the walls or floor of the [[orbit (anatomy)|orbit]]
** [[Mandibular fracture]]
** [[Nasal fracture]]
** [[Le Fort fracture of skull]] – facial fractures involving the [[maxillary bone]] and surrounding structures in a usually bilateral and either horizontal, pyramidal, or transverse way.
* [[Spinal fracture]]
** [[Cervical fracture]]
*** Fracture of ''[[Atlas (anatomy)|C1]]'', including [[Jefferson fracture]]
*** Fracture of ''[[Axis (anatomy)|C2]]'', including [[Hangman's fracture]]
*** [[Flexion teardrop fracture]] – a fracture of the anteroinferior aspect of a cervical vertebral
** [[Clay-shoveler fracture]] – fracture through the [[spinous process]] of a [[vertebra]] occurring at any of the lower cervical or upper thoracic vertebrae
** [[Burst fracture]] – in which a vertebra breaks from a high-energy axial load
** [[Compression fracture]] – a collapse of a vertebra, often in the form of [[wedge fracture]]s due to larger compression anteriorly
** [[Chance fracture]] – compression injury to the anterior portion of a vertebral body with concomitant distraction injury to posterior elements
** [[Holdsworth fracture]] – an unstable fracture [[Joint dislocation|dislocation]] of the [[Thoracic vertebrae|thoraco]] [[Lumbar vertebrae|lumbar junction]] of the [[Vertebral column|spine]]
* [[Rib fracture]]
* [[Sternal fracture]]
* [[Shoulder fracture]]
** [[Clavicle fracture]]
** [[Scapular fracture]]
* [[Arm fracture]]
** [[Humerus fracture]] (fracture of upper arm)
*** [[Supracondylar fracture]]
*** [[Holstein-Lewis fracture]] – a fracture of the [[Anatomical terms of location#Proximal and distal|distal]] third of the humerus resulting in [[Compression neuropathy|entrapment]] of the [[radial nerve]]
** [[Forearm fracture]]
*** [[Ulnar fracture]]
**** [[Monteggia fracture]] – a fracture of the proximal third of the ulna with the dislocation of the [[head of the radius]]
**** [[Hume fracture]] – a fracture of the [[olecranon]] with an associated [[Anterior and posterior|anterior]] [[Joint dislocation|dislocation]] of the [[Head of radius|radial head]]
*** [[Radius fracture]]
**** [[Essex-Lopresti fracture]] – a fracture of the [[Head of radius|radial head]] with concomitant dislocation of the [[Distal radioulnar articulation|distal radio-ulnar joint]] with disruption of the [[Interosseous membrane of the forearm|interosseous membrane]]<ref name="wheeless">[http://www.wheelessonline.com/ortho/essex_lopresti_fracture Essex Lopresti fracture] {{webarchive|url=https://web.archive.org/web/20091001213135/http://www.wheelessonline.com/ortho/essex_lopresti_fracture |date=2009-10-01 }} at Wheeless' Textbook of Orthopaedics online</ref>
**** [[Distal radius fracture]]
***** [[Galeazzi fracture]] – a fracture of the radius with dislocation of the [[distal radioulnar joint]]
***** [[Colles' fracture]] – a distal fracture of the radius with dorsal (posterior) displacement of the wrist and hand
***** [[Smith's fracture]] – a distal fracture of the radius with volar (ventral) displacement of the wrist and hand
***** [[Barton's fracture]] – an [[intra-articular fracture]] of the distal radius with dislocation of the [[radiocarpal joint]]
* [[Hand fracture]]
** [[Scaphoid fracture]]
** [[Rolando fracture]] – a [[wikt:Comminuted|comminuted]] [[intra-articular]] [[fracture]] through the base of the first [[metacarpal]] bone
** [[Bennett's fracture]] – a fracture of the base of the [[first metacarpal bone]] which extends into the [[carpometacarpal joint|carpometacarpal]] (CMC) joint <ref>{{Cite GPnotebook|1288699906|Bennett's fracture-subluxation}}</ref>
** [[Boxer's fracture]] – a fracture at the neck of a [[metacarpal]]
* [[Broken finger]] – a fracture of the carpal phalanges
* [[Pelvic fracture]]
** Fracture of the [[hip bone]]
** [[Duverney fracture]] – an isolated pelvic fracture involving only the [[Ilium (bone)|iliac wing]]
* [[Femoral fracture]]
** [[Hip fracture]] (anatomically a fracture of the [[femur]] bone and not the [[hip bone]])
* [[Patella fracture]]
* [[Crus fracture]]
** [[Tibia fracture]]
*** [[Pilon fracture]]
*** [[Tibial plateau fracture]]
*** [[Bumper fracture]] – a fracture of the [[lateral (anatomy)|lateral]] [[tibia]]l plateau caused by a forced [[Valgus deformity|valgus]] applied to the [[knee]]
*** [[Segond fracture]] – an [[avulsion fracture]] of the [[Tibia|lateral tibial condyle]]
*** [[Gosselin fracture]] – a fractures of the tibial [[synovial joint|plafond]] into anterior and posterior fragments <ref name="hunter"/>
*** [[Toddler's fracture]] – an undisplaced and spiral fracture of the distal third to distal half of the tibia <ref name="pmid10532655">{{cite journal |doi=10.1097/00006565-199910000-00001 |pmid=10532655 |title=Childhood accidental spiral tibial (CAST) fractures |journal=Pediatric Emergency Care |volume=15 |issue=5 |pages=307–9 |year=1999 |last1=Mellick |first1=Larry B. |last2=Milker |first2=Laura |last3=Egsieker |first3=Erik }}</ref>
** [[Fibular fracture]]
*** [[Maisonneuve fracture]] – a spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane
*** [[Le Fort fracture of ankle]] – a vertical fracture of the [[Anterior and posterior|antero]]-[[Human anatomical terms#Front and back|medial]] part of the [[Anatomical terms of location#Proximal and distal|distal]] [[fibula]] with [[Avulsion fracture|avulsion]] of the [[anterior ligament of the lateral malleolus|anterior tibiofibular ligament]]<ref name="hunter">{{cite journal |doi=10.1148/radiographics.20.3.g00ma20819 |pmid=10835130 |title=Radiologic History Exhibit |journal=RadioGraphics |volume=20 |issue=3 |pages=819–36 |year=2000 |last1=Hunter |first1=Tim B. |last2=Peltier |first2=Leonard F. |last3=Lund |first3=Pamela J. }}</ref>
*** [[Bosworth fracture]] – a fracture with an associated fixed [[Anterior and posterior|posterior]] [[Joint dislocation|dislocation]] of the distal fibular fragment that becomes trapped behind the [[Tibia|posterior tibial tubercle]]; the injury is caused by severe [[external rotation]] of the ankle <ref name="perry">{{cite journal |pmid=6630259 |url=http://www.jbjs.org/cgi/pmidlookup?view=long&pmid=6630259 |year=1983 |last1=Perry |first1=C. R. |title=Posterior fracture-dislocation of the distal part of the fibula. Mechanism and staging of injury |journal=The Journal of Bone and Joint Surgery. American Volume |volume=65 |issue=8 |pages=1149–57 |last2=Rice |first2=S |last3=Rao |first3=A |last4=Burdge |first4=R |doi=10.2106/00004623-198365080-00016 |url-access=subscription }}{{Dead link|date=June 2019 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>
** [[Combined tibia and fibula fracture]]
*** [[Trimalleolar fracture]] – involving the [[lateral malleolus]], [[medial malleolus]], and the distal posterior aspect of the tibia
*** [[Bimalleolar fracture]] – involving the lateral [[malleolus]] and the medial malleolus
*** [[Pott's fracture]]
* [[Foot fracture]]
** [[Lisfranc fracture]] – in which one or all of the [[metatarsal]]s are displaced from the [[Tarsus (skeleton)|tarsus]]<ref>{{Cite web |date=2009 |title=Lisfranc's fracture |url=http://medical-dictionary.thefreedictionary.com/Lisfranc%27s+fracture |url-status=dead |archive-url=https://web.archive.org/web/20190404164036/http://medical-dictionary.thefreedictionary.com/Lisfranc's+fracture |archive-date=Apr 4, 2019 |work=Mosby's Medical Dictionary |series=9th edition |publisher=Elsevier |via=The Free Dictionary}}</ref>
** [[Jones fracture]] – a fracture of the proximal end of the [[fifth metatarsal]]
** [[March fracture]] – a fracture of the distal third of one of the metatarsals occurring because of recurrent stress
** [[Cuneiform fracture]] – a fracture of one of the three cuneiform bones typically due to direct blow, axial load, or avulsion <ref>{{cite journal |last1=Mabry |first1=LM |last2=Patti |first2=TN |last3=Ross |first3=MD |last4=Bleakley |first4=CM |last5=Gisselman |first5=AS|title=Isolated Medial Cuneiform Fractures: A Systematic Search and Qualitative Analysis of Case Studies |journal=J Am Podiatr Med Assoc |volume=111|issue=4 |pages=1–9 |date=July 2021 |pmid=34478529 |doi= 10.7547/20-047|s2cid=225705519 |url=https://japmaonline.org/downloadpdf/journals/apms/111/4/i8750-7315-111-4-article_12.pdf |s2cid-access=free |url-status=dead |archive-url=https://web.archive.org/web/20220302054558/https://japmaonline.org/downloadpdf/journals/apms/111/4/i8750-7315-111-4-article_12.pdf |archive-date= Mar 2, 2022 }}</ref>
** [[Calcaneal fracture]] – a fracture of the calcaneus (heel bone)
* [[Broken toe]] – a fracture of the pedal phalanges

===OTA/AO classification===

{{main|Müller AO Classification of fractures}}

The Orthopaedic Trauma Association Committee for Coding and Classification published its classification system <ref>{{cite journal |pmid=8814583 |year=1996 |title=Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification |journal=Journal of Orthopaedic Trauma |volume=10 |issue=Suppl 1 |pages=v–ix, 1–154 }}</ref> in 1996, adopting a similar system to the 1987 [[AO Foundation]] system.<ref>{{cite book | title=Classification AO des fractures. Tome I. Les os longs | publisher=Springer-Verlag |vauthors=Müller ME, Nazarian S, Koch P | year=1987 | location=Berlin}}{{page needed|date=December 2016}}</ref> In 2007, they extended their system,<ref>{{cite journal |pmid=18277234 |year=2007 |last1=Marsh |first1=J. L. |title=Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee |journal=Journal of Orthopaedic Trauma |volume=21 |issue=10 Suppl |pages=S1–133 |last2=Slongo |first2=T. F. |last3=Agel |first3=J |last4=Broderick |first4=J. S. |last5=Creevey |first5=W |last6=Decoster |first6=T. A. |last7=Prokuski |first7=L |last8=Sirkin |first8=M. S. |last9=Ziran |first9=B |last10=Henley |first10=B |last11=Audigé |first11=L |doi=10.1097/00005131-200711101-00001 |s2cid=24535478 |doi-access=free }}</ref> unifying the two systems regarding wrist, hand, foot, and ankle fractures.

===Classifications named after people===
{{Main category|Orthopedic classifications}}
A number of classifications are named after the person ([[eponymous]]) who developed it.
* "Denis classification" for [[spinal fracture]]s <ref>{{Cite GPnotebook|1590689797|Denis classification of spinal fractures}}</ref>
* "[[Frykman classification]]" for [[forearm fracture]]s (fractures of [[radius and ulna]])
* "[[Gustilo open fracture classification]]" <ref Name="Rüedi">{{cite book|title= AO principles of fracture management, Volume 1|last= Rüedi, etc. all|author2= Thomas P. Rüedi|author3= Richard E. Buckley|author4= Christopher G. Moran|year= 2007|publisher= Thieme|isbn= 978-3-13-117442-0|page= 96|url= https://books.google.com/books?id=WEzRr4bM05gC&q=Gustilo%20open%20fracture%20classification&pg=PA96|access-date= 9 November 2020|archive-date= 26 July 2024|archive-url= https://web.archive.org/web/20240726175130/https://books.google.com/books?id=WEzRr4bM05gC&q=Gustilo%20open%20fracture%20classification&pg=PA96#v=onepage&q=Gustilo%20open%20fracture%20classification&f=false|url-status= live}}</ref>
* "Letournel and Judet Classification" for [[Acetabular fracture]]s <ref name="Fractures of the Acetabulum">{{cite web|url=http://www.wheelessonline.com/ortho/fractures_of_the_acetabulum|title=Fractures of the Acetabulum|work=wheelessonline.com|url-status=live|archive-url=https://web.archive.org/web/20090926194406/http://www.wheelessonline.com/ortho/fractures_of_the_acetabulum|archive-date=2009-09-26}}</ref>
* "Neer classification" for [[humerus fracture]]s <ref name="pmid9155417">{{cite journal |pmid=9155417 |year=1997 |last1=Mourad |first1=L |title=Neer classification of fractures of the proximal humerus |journal=Orthopedic Nursing |volume=16 |issue=2 |pages=76 }}</ref><ref name="titleeMedicine - Proximal Humerus Fractures: Article by Mark Frankle, MD">{{EMedicine|article|1261320|Proximal Humerus Fractures}}</ref>
* [[Seinsheimer classification]], [[Evans-Jensen classification]], [[Pipkin classification]], and [[Garden classification]] for [[hip fracture]]s<ref>{{cite web|url=https://www.lecturio.com/concepts/hip-fractures/|title=Hip Fractures|website=The Lecturio Medical Concept Library|access-date=24 July 2021|archive-date=24 July 2021|archive-url=https://web.archive.org/web/20210724221923/https://www.lecturio.com/concepts/hip-fractures/|url-status=live}}</ref>