Describing Fractures

Open/Closed

Open or compound fractures are exposed to the environment and therefore more likely to become infected and lead to complications. Because of this open fractures are often managed differently.

Open fractures can be categorised by the gustilo classification depending on the extent of damage to the surrounding tissues:

I - Low energy with wound less than 1cm.

II - greater than 1 cm with moderate soft tissue damage.
III - Wound greater than 1 cm with severe soft tissue damage

Where - Bone and part of bone

Describe which bone and where on the bone the fracture is, long bones are usually divided into distal (away from body), middle and proximal(closer to body)3rds of the bone,or can be described as a mishaft fracture if the fracture is in the middle. Other bones have particular landmarks which are more prone to fractures or relevant to management. For example, hip fractures can be described as intracapsular or extracapsular fractures.

Pattern and number of fragments:

Tilt and rotation:

What is the angle of the distal portion compared to the proximal part of the bone?

Degree of tilt and rotation may affect the function of the bone or aesthetic features of the injured part depending on the bone injured and may need to be corrected.

Displacement :
Described as the % of the distal fragment which is displaced relative to the proximal segment.


Intra-articular involvement:
Fractures which extend into the joint may cause long term complications if it is not reduced well.

Physeal involvement:

In children, fractures can often affect the growth plates which are weaker compared to the rest of the bone. fractures involving growth plates may disrupt growth. The likelihood and extent of that, and subsequent management depends on the pattern of the Fracture. These are classified according to the Salter criteria which can be remembered by the mneumonic SALTER

      Slip

          Above 

  beLow

                Transverse

comprEssion

        periosteal Ring of la croix

Soft tissues:
Any bruising, swelling or lacerations?

Neurovascular status
Determining neurovascular status of the limb is crucial as delayed management can lead to irreversible complications. Feel for pulses, check for capillary refill, and test for sensations in the dermatomes and motor function.

references
http://www.pemdatabase.org/Fractures.html