Chart — Musculoskeletal
Fracture Type Comparison
Fracture vocabulary describes two things: whether the skin is broken (open vs closed) and the geometry of the break. Both matter to nursing care — the first sets the infection risk, the second hints at the force involved and the stability of the repair.
Educational use only. Fracture classification and management decisions are made by the provider from imaging; this chart is for study and pattern recognition. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Fracture Types at a Glance
| Type | Pattern | Typical Mechanism | Nursing Implications |
|---|---|---|---|
| Closed (simple) | Bone breaks; skin stays intact | Direct blow, fall, twisting | Neurovascular checks, swelling control, immobilization integrity |
| Open (compound) | Bone breaks through skin, or wound communicates with the fracture | High-energy trauma | Sterile coverage, never reposition protruding bone, tetanus and early antibiotics per orders — infection/osteomyelitis is the headline risk |
| Comminuted | Bone shatters into three or more fragments | High-energy or crush injury | Often needs surgical fixation; high soft-tissue damage — watch compartments and blood loss |
| Greenstick | Incomplete break — one cortex bends, the other cracks | Pliable young bone; falls in children | Pediatric pattern; assess for abuse only when story and injury conflict; usually casted, heals well |
| Spiral | Fracture line twists around the shaft | Rotational/twisting force | In a non-ambulatory child, a classic abuse red flag — pattern and history must match |
| Transverse | Straight line across the shaft | Direct perpendicular force | Generally stable after reduction; standard fracture care |
| Oblique | Diagonal line across the shaft | Angled force | Less stable than transverse; watch alignment after reduction |
| Compression | Bone is crushed — vertebral bodies collapse | Axial load; osteoporosis with minimal trauma | Think fragility fracture: pain control, mobility, osteoporosis work-up and fall prevention teaching |
| Stress (fatigue) | Hairline crack from repetitive load | Overuse — runners, military recruits | Often normal early X-rays; activity modification and graded return |
| Pathologic | Break through diseased bone | Minimal force on bone weakened by tumor, osteoporosis, infection | Investigate the underlying disease; handle gently — more bone may be fragile |
Reading the Chart Like an Exam Question
Exam stems usually encode the fracture type in the mechanism: a toddler’s arm bent the wrong way is a greenstick; a runner with weeks of worsening shin pain and a clean X-ray is a stress fracture; an older woman with sudden back pain after lifting groceries is a vertebral compression fracture; a bone that broke during normal activity is pathologic until proven otherwise.
Two patterns carry safety flags beyond the bone itself: open fractures (infection clock starts at injury) and spiral fractures in children who are not yet walking (the history must explain the torsion — escalate per protocol when it cannot).
NCLEX Pearls
- ✦Open fracture = sterile dressing over the wound, no repositioning of bone, infection prophylaxis per orders — first.
- ✦Greenstick fractures belong to children; compression fractures to osteoporotic spines.
- ✦Spiral fracture + non-ambulatory child + vague history = mandatory abuse evaluation.
- ✦Comminuted and crush patterns carry the highest compartment syndrome risk — assess accordingly.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Orthopaedic Surgeons (AAOS) · National Association of Orthopaedic Nurses (NAON). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →