How to describe a fracture

Written by the X-Ray Atlas editorial team from the sources listed below · Medical review pending · Updated 24 October 2026 · Level: Beginner

A good fracture description lets someone who cannot see the film picture the injury accurately: the orthopaedic registrar on the phone, the plaster room, or the clinician reviewing the patient next week. Vague terms such as "a bit displaced" or "broken wrist" cause real errors. This page gives you a template that works for any bone: views → bone and side → location → pattern → displacement → joint involvement → soft tissues, together with the "rule of twos" that stops you missing the second injury.

1. Before you describe: how to look (ABCS)

• A: Adequacy and alignment. At least two views at right angles. Is the whole bone, and the joint above and below where relevant, included? Are the joints congruent?
• B: Bones. Trace every cortex all the way round. Look for a lucent line, a sclerotic band (impaction), a step, a buckle or a break in the trabecular pattern. Note the overall bone density.
• C: Cartilage and joints. Joint space width and symmetry, effusion (displaced fat pads), loose bodies.
• S: Soft tissues. Swelling, gas, foreign bodies, and a lipohaemarthrosis (a fat–fluid level on a horizontal-beam view, which indicates an intra-articular fracture even if no line is seen).

2. Bone, side and location

Start with the basics: which views, which bone, which side. Then say exactly where on the bone:

Region	Meaning
Diaphysis	The shaft. Divide it into proximal, middle and distal thirds.
Metaphysis	The flared end of the shaft next to the growth plate or its remnant.
Physis	The growth plate, in children. Fractures through it are described with the Salter-Harris classification.
Epiphysis	The end of the bone beyond the physis, forming the joint surface.
Intra-articular or extra-articular	Does the fracture line reach the joint surface?

Use named landmarks where they exist: the surgical neck of the humerus, the waist of the scaphoid, the base of the fifth metatarsal, the femoral neck. These carry specific implications for blood supply and treatment.

3. Fracture pattern

Pattern	Description	Typical mechanism or note
Transverse	Perpendicular to the long axis	Direct blow or bending force
Oblique	At an angle of less than 90° to the long axis	Often unstable once displaced
Spiral	Winds around the shaft	Twisting force. In a child who is not yet walking, a spiral long-bone fracture should prompt consideration of non-accidental injury
Comminuted	More than two fragments	High energy, or weak bone
Segmental	Two separate fracture lines isolating a segment of shaft	High energy; risk to the blood supply of the segment
Butterfly fragment	A wedge-shaped fragment at one side	Bending force
Avulsion	A small fragment pulled off by a tendon or ligament	Small fragment, but may signal a significant ligament injury
Impacted (compression)	Fragments driven into each other; often a sclerotic band rather than a lucent line	Femoral neck, vertebral body, distal radius
Pathological	Through abnormal bone (tumour, metastasis, cyst)	Look for a lesion around the fracture
Stress or insufficiency	Repetitive load on normal bone, or normal load on weak bone	Often invisible early; MRI is more sensitive

Children have additional patterns because their bones are more flexible: buckle (torus), greenstick, plastic bowing and physeal fractures. See buckle and greenstick fractures.

4. Displacement: the distal fragment moves

By convention, describe the position of the distal fragment relative to the proximal one. Cover four elements:

• Translation (shift): which direction, and how much, as a percentage of the shaft width or in millimetres. "50% dorsal translation", "translated by a full shaft width".
• Angulation (tilt): in degrees, and in which direction. There are two conventions, and both are in use:
  • the direction the apex of the angle points (for example "apex volar"), or
  • the direction the distal fragment tilts (for example "dorsal angulation of the distal fragment").
  These describe the same deformity in opposite words: dorsal tilt of the distal fragment equals apex-volar angulation. Always say which convention you are using.
• Rotation: hard to judge on plain films. It needs both joints on the film, or clinical assessment (for example, finger scissoring in a metacarpal fracture).
• Length: shortening (fragments overlap or impact) or distraction (a gap between them).

If the fragments are in their normal position, say "undisplaced" (non-displaced). If you can't judge one element from the views available, say that too.

5. Joints, soft tissues and clinical features

• Joint involvement: does the fracture extend into the joint? If so, how large is the articular step-off or gap, in millimetres? Is there an associated dislocation or subluxation?
• Soft tissues: gas in the soft tissues near a fracture may mean an open fracture (or a wound). Note foreign bodies, effusion and displaced fat pads.
• Clinical features not on the film: whether the fracture is open or closed, and the neurovascular status. You cannot judge these from the radiograph, but a complete handover includes them.

Many sites have their own classification systems (Garden for the femoral neck, Weber for the ankle, Gartland for the paediatric supracondylar humerus, Neer for the proximal humerus, Salter-Harris for physeal injuries, and the comprehensive AO/OTA system). Use them where they add value, but a clear plain-language description is always required first.

6. The rule of twos

Two…	Why
Views	At least two at right angles. Fractures and dislocations can be invisible on one view.
Joints	Include the joint above and below for long-bone injuries, especially the forearm and lower leg. See Monteggia and Galeazzi.
Sides	Comparison with the other side, used selectively (mainly in children, where it should not be routine).
Occasions	Some fractures appear only on repeat imaging after 10–14 days, for example the scaphoid. MRI or CT may be used earlier, depending on local pathways.
Opinions	Ask a senior or radiologist when uncertain.

7. Putting it together

Note what this description does. It states the views and side first, uses a single convention for angulation, gives numbers, comments on the joint, and only names the eponym at the end. See distal radius fractures and how to present an X-ray.

8. Common pitfalls

• Satisfaction of search. Finding one fracture makes you less likely to see a second. The radial fracture with a missed ulnar styloid, or the ankle fracture with a missed fifth metatarsal base, are classic examples.
• Normal structures mistaken for fractures: growth plates, unfused ossification centres, nutrient canals and accessory ossicles. Use an atlas of normal variants. See artefacts and mimics.
• Mixing angulation conventions. "Dorsal angulation" can mean opposite things to two listeners unless you specify.
• Missing a pathological fracture. Look at the bone around the fracture for a lytic lesion, especially after minimal trauma.
• A normal film does not exclude a fracture, especially of the scaphoid, the femoral neck in older people, or stress fractures. If clinical suspicion remains, follow the local pathway for further imaging. See hip fracture.

Red flags: act now

What to focus on, by role

Role	Priorities
Medical student	Learn the template and the vocabulary. Practise describing a film in full sentences without naming the eponym until the end.
Nurse / ENP	Recognise common fractures of the hand, wrist and ankle, check the neurovascular status, and escalate open fractures and dislocations.
Junior doctor	Give a referral-quality description with numbers, check the joint above and below, and know when a normal film needs further imaging.
Radiographer	Two views, the right extra views, and preliminary clinical evaluation comments using precise language.
Advanced / FRCR	Classifications (AO/OTA, Garden, Weber, Gartland, Salter-Harris) and subtle injuries in rapid reporting.

Practise describing fractures →

References

1. Radiology Masterclass. Fracture description. radiologymasterclass.co.uk
2. AO Foundation / Orthopaedic Trauma Association. AO/OTA fracture classification. aofoundation.org
3. NICE. Fractures (non-complex): assessment and management (NG38). nice.org.uk
4. British Orthopaedic Association. BOAST standards. boa.ac.uk
5. NICE. Child maltreatment: when to suspect maltreatment in under 18s (CG89). nice.org.uk

For education only. Not a substitute for a formal report, senior review or your local policy. Never use this page to make decisions about a real patient.