Introduction 

Bones are strong structures made up of various minerals and proteins, notably calcium, phosphate, and collagen.³ It facilitates in supporting our muscles, tendons, organs, and soft tissue, acting as a structural anchor in our body. However, despite its robust framework, they are susceptible to injury in the form of breaks, also known as fractures.² 

 However, the method required to treat these fractures depends not only on the angle of the fracture, but also whether or not the bones are where they are supposed to be located. This therefore, introduces various different types of fractures in which healthcare providers (HCPs) must identify to ensure proper treatments are provided.

The two types of fractures we are going to explore today are transverse and oblique fractures. Both fractures are considered to be “complete” fractures; they both travel all the way across the bone. The most significant difference between both types is the angle at which they occur.¹

Types of fractures and their angles 

Open vs closed fractures 

Firstly, your healthcare practitioner (HCP) will identify whether your fracture is “open” or “closed”. An open fracture is one in which the bone protrudes out from the skin, whereas a closed fracture is contained within the skin.⁴ Open fractures are a serious medical emergency and are often treated with surgery, hospitalisation, and antibiotics. Open fractures are also known to be especially complicated and can take much longer to heal. 

Transverse fracture

Transverse fractures:

• Run horizontally and perpendicular (≈90°) to the length of the bone⁴ 
• Are mostly found in the long bones of the body (e.g. legs, arms, and collarbone)⁴

Oblique fracture

Compared to transverse fractures, oblique fractures:

• Run at an angle of approximately 30-60° to the bone
• Are also most often seen in the long bones of the body¹ 

What causes these types of fractures?

It demands a strong force to bend and break a bone. However, it is important to note that the type of fracture is determined by the angle of its force. A perpendicular force often leads to a transverse fracture. On the other hand, a force coming at an angle, either from above or below, often causes an oblique fracture. 

Despite that, fractures that are caused by trauma may have different angles depending on the nature of the trauma. However, there is one condition that predisposes a person to all types of fractures, and these are patients with osteoporosis; a condition that causes weakened bones. People who experienced osteoporosis are much more susceptible to all fractures and can sometimes be prone to more complications than a healthy person.¹

Causes of transverse fractures 

Transverse fractures are often caused by a forceful hit. Falls and car accidents are known to be two of the most common causes of transverse fractures. To understand what type of force leads to a transverse fracture, you might want to picture a bone getting hit by a direct blow to the side or bending forces perpendicular to the bone. For example, picture a car that gets T-boned, the force typically directs at a perpendicular angle to the bone, thus causing a transverse fracture.²

Causes of oblique fractures

Conversely, oblique fractures are often from torsional injuries. They can also be caused by an indirect force, but typically, it is a direct force being applied at an angle. Similar to transverse fractures, oblique fractures are mostly caused by twisting or angled compressive forces, for example from falls or car accidents.¹

How do different types of fractures affect your treatment?

Diagnosis of fractures 

Diagnosis of all fractures typically starts with an x-ray, which is a machine that uses radiation to create pictures of the bones in your body. A skilled professional or an HCP will look at these images to determine if there is a fracture or not. Sometimes, if a fracture is more complex, your HCP may order a more advanced study such as a CT instead. While an x-ray is a 2D image, a CT is a 3D image composed of tons of x-rays taken at all different angles. 

Treatment of transverse fractures 

One of the most crucial aspects that determines the type of treatment is whether the fracture is nondisplaced (in alignment) or displaced (out of alignment). If a fracture is non-displaced, it often can be placed in a splint or cast. However, a displaced fracture may require a method called “reduction” or surgery to fix it before it is immobilised..

Treatment of oblique fractures

The thing that makes treating oblique fractures a bit more tricky is that they can be prone to slipping or displacement. Even if it is adjusted back into place by your HCP, it tends to slide back out of place due to its angle. It is this trait that makes oblique fractures slightly more difficult to treat than transverse fractures. In order to prevent the fracture from sliding out of place once aligned, it sometimes has to be locked in place by a method called “surgical fixation.” This is when a surgeon uses a combination of plates, screws, and other hardware to lock the bone in place once it has been re-aligned.

Healing of different fractures 

Treatment plan

Once the bones are in alignment, most fractures can be treated by splinting or casting. Whilst both treatments have similar properties, a splint is known to be slightly more flexible, whereas a cast is hard and not very flexible. 

It is crucial for the first week after an injury that a patient is in a splint, which will protect the fracture while allowing it to swell safely. If a patient is placed in a cast before swelling is finished, it can lead to a limb-threatening condition called “compartment syndrome.” This condition is considered to be a serious medical emergency, it is essential it's important to speak to your HCP to determine which treatment is right for you.

Healing process 

While both transverse and oblique fractures will eventually require splinting, casting, and physical therapy, oblique fractures may take slightly longer to heal due to their higher probability of needing surgery. Oblique fractures can also sometimes have a little bit more movement at the fracture site, which can prolong healing. However, the duration to heal depends on several factors, including:

• type of fracture
• severity of fracture
• location of fracture
• type of treatment used to heal fractures

In general, you should expect the process from start to finish to take a few months.¹

Follow-up visits 

Follow-up visits are critical for HCPs to track the progress of your fracture healing. You will likely be scheduled for multiple follow-ups over the next few months. Your HCP will monitor for alignment, healing progression, and complications. It is important to attend these follow-up appointments so you don't end up with a higher risk of malunion (improper healing) or delayed union (delayed healing), which can often happen with oblique fractures.

Summary

While most fractures are treated similarly, the fracture angle has a much bigger impact than you think due to the mechanism of injury and treatment strategy. Due to this, it's important to consult a healthcare professional at the time of injury to ensure correct identification of the type of fracture, which improves patient outcomes. Understanding these differences is crucial in orthopedic and trauma care.