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 film
What film (or films) 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:
- complete: all the way through the bone
- incomplete: the whole cortex isn't broken
- Salter-Harris: fractures that involve the growth plate
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've got an idea of where it is and what type of fracture it is, you need to be able to describe what is 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 comes in three flavours:
V: Is something else going on?
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.
Always finish off by checking for other fractures. Also, check that you have imaged enough of the patient. If they have pain in the joint above or below a fracture, it may well be worth getting an x-ray of that joint too.
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.
describing a fracture
- fracture types
- fracture location
- diaphyseal fracture
- metaphyseal fracture
- epiphyseal fracture
- fracture displacement