Describing Fractures

When consulting for fracture care, it is important to provide an accurate description of findings over the phone. This is important to improve patient outcome, ensure consultants are well informed of the patient's condition, and to ensure appropriate documentation of a patient's injuries.

Wet read

Every potential fracture site requires at least two views to fully evaluate for injury. You should also be imaging the joint above and below the injury as well. When reading your imaging, make sure you identify any joint involvement, and second fractures that may be present, as well as lines and tubes. 

Naming fractures

The menemonic OLD ACID can be used to describe fractures

• O: Open vs Closed Is the fracture open, or 'compound' i.e. open to air 
• L: Location Which bone is involved, and what part of the bone? In long bones, identify the epiphysis, metaphysis, diaphysis, or physis, as well as the articular surface. Anatomic landmarks, such as head, neck, body, shaft, base, or condyle. 

• D: Degree of fracture A complete fracture will include the entire cortical circumference, and fragments are completely separated. Incomplete fractures, such as a Greenstick fracture, does not compromise the entire cortex.
• A: Articular Extension Identify any involvement of the intra-articular surface, as well as any dislocation.
• C: Comminution/ Pattern Fractures can have multiple patterns of fracture, depending on the forces involved. Atypical fracture patterns include impacted, hairline, torus (buckle) and pathologic fractures. Bones with multiple fractures are segmental, and should be called comminuted if there are three or more segments.

• I: Intrinsic bone quality Identify any osteopetrosis or osteopenia
• D: Displacement, angulation, rotation. Displacement idenfities fracture fragments are not axially aligned. Identify displacement of distal compared to medial. i.e. laterally displaced. Angulation of a fracture is relative to the anatomic position of the fracture compared to the proximal bone. Medial angulation is Varus Angulation, while lateral angulation is Valgus Angulation. Rotation of a fracture is either internal or external. 

Specific consult question

When consulting, ensure you have a specific consult question, especially when a consultant may not be in the hospital or may not have access directly to imaging.