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 is not 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 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?
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.
- stress fracture
- pathological fracture
- fracture location
- fracture types
- fracture displacement
- skull fractures
- fractures involving a single facial buttress
- complex fractures
- cervical spine fracture classification systems
- thoracolumbar spinal fracture classification systems
- three column concept of spinal fractures (Denis classification)
- classification of sacral fractures
- spinal fractures by region
- cervical spine fractures
- thoracic spine fractures
- lumbar spine fractures
- sacral fractures
- spinal fracture types
upper limb fractures
- Rockwood classification (acromioclavicular joint injury)
- Neer classification (proximal humeral fracture)
- AO classification (proximal humeral fracture)
- Mason classification (radial head fracture)
- Frykman classification (distal radial fracture)
- Mayo classification (scaphoid fracture)
- Hintermann classification (gamekeeper's thumb)
- upper limb fractures by region
- carpal bones
- rib fractures
- pelvic fractures
- lower limb fractures