Describing a fracture (an approach)

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Describing a fracture is a basic requirement when making an assessment of a plain radiograph. There are many ways to approach the assessment of the radiograph; this is just one approach.

I: Describe the radiograph

What radiograph (or radiographs) are you looking at? Check the who, what, why, when, and where.

II: What type of fracture?

When describing a fracture, the first thing to mention is what type of fracture it is. Broadly, these can be split into:

III: Where is the fracture?

The next thing to describe is the bone that is involved and what part of the bone is affected:

  • diaphysis: the shaft of the bone
  • metaphysis: the widening portion adjacent to the growth plate
  • epiphysis: the end of the bone adjacent to the joint

In some cases, you will use the anatomical name for a part of the bone, e.g. the metacarpals have a base, shaft, neck, and head.

IV: Is it displaced?

Once you have an idea of where it is and what type of fracture it is, you need to be able to describe what it looks like.

Fracture displacement describes what has happened to the bone during the fracture. In general, when describing a fracture, the body is assumed to be in the anatomic position and the injury is then described in terms of the distal component displacement in relation to the proximal component.

Displacement can include one or more of:

V: Is something else going on?

Joint involvement?

It is really important to determine whether the joint surface is involved by the fracture. If the fracture does extend to the joint, the patient will probably need to have a different treatment, and it is much more likely that they will need a surgical procedure.

Another fracture?

Always finish off by checking for other fractures. Also, check that you have imaged enough of the patient. If they have pain in the joints above or below a fracture, it may well be worth getting an x-ray of that joint too.

Underlying bone lesion?

Assess the underlying bone.  Is it normal or could there be an abnormality making this a pathological fracture?  The underlying bone abnormality could be aggressive or non aggressive in nature.

Examples

With all that considered, here are some descriptions of fractures:

  • transverse fracture of the mid-to-distal third of the right tibia. No significant angulation, but ventral (80%) and lateral (10%) translation.
  • spiral fracture of the distal third of the left tibia. Mild varus angulation, lateral translation and angulation. The fracture does not extend to the joint surface.
  • buckle fracture of the left distal radius with no significant displacement.
    • Fractures