Fractures Caused by Indirect Application of Force

Indirect fractures are produced by a force acting at a distance from the

fracture site. In this regard, it should be noted that bone is weaker to tension
(stretching) than compression. Indirect fractures can be classified into six
types (Figure 4.15):
1. Traction
2. Angulation
3. Rotational
4. Vertical compression
5. Angulation and compression
6. Angulation, rotation, and compression fractures
In traction fractures, the bone is pulled apart by traction. An example
would be violent contraction of the quadriceps muscle with resultant transverse
fracture of the patella. In angulation fractures, the bone is bent until
it snaps. The concave surface is compressed and the convex surface is put
under traction. This usually results in a transverse fracture.
In rotational fractures, the bone is twisted and a spiral fracture is
produced. Spiral fractures occur only when the bone is subjected to torsional
force. In the femur, most spiral fractures occur in the proximal
third. The proximal and distant ends of a spiral fracture are connected by
what Porta et al. call a hinge.8 The hinge distinguishes it from an oblique
fracture. To determine in which direction a bone was twisted, ascertain
the direction the spiral runs from the end twisted. This indicates the
direction of torque.
Vertical compression fractures produce an oblique fracture of the body
of long bones, with the hard shaft of the long bone driven into the cancellous
end. In femurs, a T- or Y-shaped fracture is typically seen at the distal end
of the femur. Such fractures may occur following impaction of the end of
the femur into the instrument panel in motor vehicle crashes.
Blunt Trauma Wounds 113
In angulation and compression fractures, the fracture line is curved,
with an oblique component due to compression, and a transverse component
due to angulation. The last category is angulation, rotation, and compression
fractures. The angulation plus rotation produces an oblique fracture,
with the compression increasing the tendency toward fracture.