Introduction:
A fracture is a break in the continuity of a bone due to mechanical force. Accurate classification and imaging are essential for diagnosis, surgical planning, and prognosis. Radiologists play a pivotal role in identifying fracture types, associated injuries, and complications.
Fracture Classification:
Fractures can be classified based on several criteria:
✅ A. Based on skin integrity:
- Closed (simple): Skin is intact.
- Open (compound): Skin is breached; high risk of infection.
✅ B. Based on fracture pattern:
| Type | Description |
|---|---|
| Transverse | Horizontal fracture across the bone. |
| Oblique | Diagonal fracture. |
| Spiral | Twisting injury, corkscrew appearance. |
| Comminuted | Bone broken into multiple fragments. |
| Segmental | Two fractures creating a bone segment in between. |
| Greenstick | Incomplete fracture (children). |
| Torus/Buckle | Bulging of cortex (pediatric). |
| Impacted | One bone fragment driven into another. |
✅ C. Based on displacement:
- Non-displaced
- Displaced (angulation, rotation, translation)
- Distracted or Overridden
✅ D. Based on location:
- Epiphyseal / Metaphyseal / Diaphyseal
- Intra-articular vs Extra-articular
✅ E. Based on Salter-Harris Classification (Pediatric):
| Type | Description |
|---|---|
| I | Through physis only |
| II | Physis + metaphysis |
| III | Physis + epiphysis |
| IV | Epiphysis + physis + metaphysis |
| V | Compression injury of physis |
✅ F. Based on mechanism:
- Fatigue/stress fractures: Repeated stress.
- Pathological fractures: Through abnormal bone (e.g., metastasis).
- Insufficiency fractures: Normal stress on weak bone (e.g., osteoporosis).
Imaging Approach to Fractures:
🩻 1. X-Ray (Primary modality):
- First-line imaging for trauma.
- Orthogonal views (2 views at 90°) are essential.
- Common views:
- AP + Lateral
- Oblique, stress, or special views if needed.
- Look for:
- Fracture line, displacement, angulation, step-off
- Joint involvement, fat pad signs, periosteal reaction
💡 2. CT Scan:
- Indicated when:
- Complex fractures (comminuted, intra-articular)
- Occult fractures not seen on X-ray
- Preoperative planning
- 3D reconstructions help in surgical decision-making.
Examples:
- Acetabular fractures
- Spine fractures (AO classification)
- Calcaneal, facial bone, or tibial plateau fractures
🧠 3. MRI:
- Best for stress fractures, occult fractures, and marrow edema.
- Useful in pediatric fractures when growth plate injury is suspected.
- Evaluates associated ligamentous and soft tissue injuries.
☢️ 4. Nuclear Medicine (Bone Scan):
- Shows increased uptake in fracture site within 48–72 hours.
- Used for:
- Occult/stress fractures
- Polytrauma with unclear pain focus
- Pathological fractures
🧬 5. Ultrasound (Limited role):
- Can detect cortical disruption in superficial bones (ribs, nasal bones, infants).
- Especially useful in pediatric epiphyseal injuries.
Approach Summary:
- Clinical history & trauma mechanism
- Initial X-ray – 2 views
- CT if fracture complex, intra-articular or unclear
- MRI for occult/stress fractures or ligamentous injuries
- Bone scan for unclear site/pain or multiple injuries
Conclusion:
Fracture classification helps guide treatment and prognosis, while imaging confirms the diagnosis and delineates extent and associated injuries. A structured approach using X-ray as the first step, with CT/MRI as needed, ensures accurate and timely management.
