‘Fracture’ is the medical term for a broken bone. There are multiple ways in which a bone can break, and these will be determined by the pressure, injury and activity that causes the bone to break. 

Introduction

An oblique fracture is one of the types of fractures that can occur when a bone is broken at an angle.

There are various types of bone fractures. The different categorisations help doctors to assess and quantify the location, damage and type of fracture they are dealing with.

Firstly, there are open and closed fractures.

Closed fractures mean that the bone has broken but remains within the skin. 

Contrary to closed fractures are open fractures, where the bone protrudes from the skin.¹

Then there are displaced and non-displaced fractures.

Non-displaced bone fractures are where the bone has broken but stayed in place. There may be swelling and pain in the area, but it will stay normally aligned and in shape.

Displaced fractures are fractures where the bone fragments have moved out of line. This can result in the area at the site of the fracture looking oddly shaped, bent or twisted at an unnatural angle. 

Types of a fractures depend on how the bone is impacted.

Table 1: Various types of fractures and their definitions.^5,6

This article will focus on oblique fractures specifically; what they are, how they come about, common places for it to happen, and recognising and treating them.

Characteristics of oblique fractures

Oblique fractures are a diagonal break through a bone. They usually occur in the longer bones in the body.^[7] This can include bones of the leg such as the tibia, fibula and femur, the collarbone(the clavicle), or bones in the arm such as the humerus, ulna or radius.

Oblique fractures are usually caused by impact or trauma.⁸ Putting pressure on the longer bones in the body can cause the diagonal break through the bone which is characteristic of an oblique fracture. This can be through a fall, impact, or trauma such as car crashes or sports injuries.⁹ An example of an oblique fracture is demonstrated below in figure 1.

Clinical presentation

The signs and symptoms of an oblique fracture are similar to many other fractures. There will often be a lot of pain, localised swelling and redness, bruising, and sometimes reduced or affected mobility. There can be deformities, like lumps or misshapen forms of the area where the break has occurred.⁴ 

Consult a healthcare professional if a fall, impact or trauma has happened along with pain, affected mobility, affected weight-bearing or any other signs and symptoms. The medical professional is likely to observe the injury and symptoms and ask questions about how the injury occurred. They are also likely to assess the pain, mobility, and location of the injury. Imaging is ordered to confirm the diagnosis and the extent of the injury.

The imaging technique ordered will be an X-ray in the majority of cases. This allows a clear view of the bones in an area, to confirm a break, and type of break. 

In occasions where an X-ray is inconclusive, a CT or MRI scan can be ordered which shows bones as well as soft tissue in the area. This can be used to assess damage to bones, as well as the ligaments, tendons and other tissues which could be damaged.

Treatment approaches

Immediate first aid may be applied on the scene to minimise further damage after the injury has occurred. Firstly, it is important to minimise or avoid any movement of the area, as this could worsen any damage to the area and lead to further future complications. However, in the event that there is severe bleeding in the area, the bleeding must be stopped by the application of pressure in the area. Open fractures, where some bone is visible through the skin should be treated by application of a sterile bandage. No attempt should be made to push the bone back into place or to realign the injured area without the presence and intervention of a healthcare professional.

If there is no bleeding, the area suspected of a fracture should be immobilised as far as possible, with a cushion or by holding or supporting the body in place.

Emergency health care should be called immediately so that treatment can be sought without delay.

Upon intervention by a healthcare professional, there are different treatment and recovery routes.

Most oblique fractures can be healed by the use of a plaster cast to immobilise the area and allow the body to naturally heal the injury without major intervention. Plaster casts are often in place for around six weeks, depending on the age and health of the patient. In some cases, if the fracture is severe, the bone is out of place or not setting itself correctly, surgical intervention may be required. In some cases, pins, wires and supports can help to reset the bone and keep it in place.^[

In some cases, physiotherapy is recommended to restore and maintain strength and range of motion in the area. Additionally, in cases where surgery was required, careful monitoring for healing and infection prevention is also important. In both surgical and non-surgical cases, monitoring the healing process is important to ensure that the bone is healing properly and aligned.

Complications and risk factors

Osteoporosis, a condition reducing the strength and integrity of bones can be a risk factor for oblique fractures. People suffering from this condition have a much higher chance of suffering from oblique fractures. Previous damage to a bone can also increase susceptibility to fractures. Other conditions include significantly low or high BMI, some organ failure diseases, specifically kidney, and other chronic conditions.¹³

Young, fit and healthy people with no underlying problems are likely to heal fractures quicker, with fewer complications and difficulties. Conditions such as osteoporosis (weakened bones), older individuals, people with poor nutrition or other health problems can contribute to slow healing times, worse outcomes, and sometimes the need for lengthy or more intrusive medical intervention.¹³

Most fractures heal easily, but some cases may include complications. This can range from soft tissue damage in the area, such as muscles, nerves and blood vessels, or infections from the wound or the surgery. These complications will likely require lengthy and more invasive treatment. Healing can also occur misaligned, where the bone does not heal in the correct position. Another complication is compartment syndrome characterised by muscular swelling in the area caused by the break or the plaster cast. Both of these complications will likely require further surgery as soon as possible.^[ 

Prevention strategies

Prevention of oblique fractures can consist of avoiding rough or contact sports, or any activities which can increase the chances of serious injury and fractures. It is recommended to use protective equipment such as seatbelts in cars or protective sporting kits such as goalkeeper padding and use the correct technique in sports such as rugby. Additionally, in elderly or more frail people who are at risk of falls which may lead to oblique fractures, installing accessibility equipment such as handrails and shower seats may help minimise injury from falls.

Additionally, maintaining a healthy weight and active lifestyle can minimise pressure on bones and joints and help protect against impact injuries such as oblique fractures. Additionally, good soft tissue health from strength and activity can help with stability and strength and reduce the fragility of a bone that might lead to fractures. Finally, people suffering from osteoporosis are at high risk of fractures and should carefully follow medical advice to minimise the risk of injury.¹³

Conclusion

In conclusion, oblique fractures are a category of bone break categorised by a slanting break through the longer bones in the body. They are, in the vast majority of cases, caused by pressure being put through the bone, often in trauma instances. This could be a fall, a car crash, or a contact sport. The longer bones which are at risk for this type of fracture are the clavicle (collarbone), the main bones in the arm, the ulna, radius and humerus, and the major bones in the leg, the tibia, fibula or femur. Symptoms of any fracture, including oblique fractures are swollen, red, painful, and occasionally disfigured areas around the bone. 

The mobility in the area may be partially or drastically reduced. If an oblique fracture is suspected, medical intervention should be sought immediately, and efforts made to support and immobilise the affected area along with stopping the bleeding if required. Medical professionals will mostly use examinations and x-rays to diagnose oblique fractures, after which treatment can involve a range of options from immobilising the area with a plaster cast, to surgical options in extreme cases or physiotherapy to restore mobility, and strength to aid in the healing process.