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Commonly Encountered Fracture Types in Rehabilitation

Original Editor - Stacy Schiurring

Top Contributors - Stacy Schiurring, Ewa Jaraczewska and Jess Bell  

Fracture Prevalence Worldwide

Fractures represent a significant global health burden. In 2019, there were an estimated 455 million prevalent cases involving acute or long-term symptoms related to fractures worldwide. Osteoporosis alone is responsible for more than 8.9 million fractures annually, that is equivalent to one fracture every three seconds.[1] Although global age-standardised fracture incidence rates have slightly decreased from 1990 to 2019, the absolute number of fractures has risen substantially due to population growth and aging demographics.[2]

In rehabilitation practice, the most commonly encountered fractures include distal radius fractures, hip fractures, vertebral compression fractures, and ankle fractures. Vertebral fractures, in particular, occur approximately every 22 seconds worldwide among individuals over the age of 50.[2] For rehabilitation professionals, understanding the epidemiology, mechanisms, and treatment strategies for these common fracture types is essential to delivering evidence-based care and optimising functional outcomes across diverse patient populations.

Fracture Mechanisms

Trauma-Related Fractures. High-energy mechanisms including motor vehicle accidents, falls from height, sports injuries, and physical violence (direct blows) account for the majority of fractures in younger populations. Road traffic crashes represent approximately one-third of injury-related deaths globally, with fractures being a significant component of trauma presentations. Sports-related fractures show sport-specific patterns, with contact sports having higher rates of acute fractures from direct impact mechanisms.[3]

Osteoporosis and Fragility Fractures. Fragility fractures result from low-energy trauma, such as a fall from standing height or less, and are the main clinical consequence of osteoporosis. Hip and vertebral fragility fractures are associated with significant morbidity and mortality in older adults, particularly those over 65 years.[4] Due to population ageing and changing lifestyle habits, osteoporosis prevalence has risen significantly and will continue to increase.[2] Pathological fractures occur through weakened bone from malignancy, metabolic bone disease, or infection, requiring minimal force to cause structural failure.[5]

Overuse and Repetitive Strain. Stress fractures represent the skeleton's inability to withstand repetitive mechanical loading, resulting in structural fatigue with localised pain and tenderness. Risk factors include both extrinsic elements (training intensity, equipment, environment) and intrinsic factors (bone density, biomechanics, hormonal status). These are particularly common in military recruits, runners, and dancers.[6]

Optional reading: Before reading about specific fractures and current recommended interventions, please review this article about weight-bearing precautions.

Upper Extremity Fractures

Proximal Upper Extremity Fractures

Xray image of a severe clavicle fracture

Clavicular fractures demonstrate a two way distribution affecting young males through sports and traumatic mechanisms and older patients through fall-related injuries. Direct blows to the shoulder or indirect forces transmitted through falls onto outstretched hands typically cause these injuries, with the middle third of the clavicle affected in 80% of cases. Most middle-third fractures can be managed conservatively using sling immobilisation or figure-8 bandages, though surgical intervention with plate fixation is increasingly used for displaced fractures, non-unions, or cases with specific indications such as significant shortening or cosmetic concerns.[7][8]

Xray image of proximal humerus fracture

Proximal humerus fractures tend to occur in one of two distinct patterns in mechanism and patient demographics. Firstly in older populations these fractures predominantly result from low-energy trauma, particularly falls from standing height, with a notable seasonal variation showing increased incidence during winter months. Secondly, younger adults typically sustain these injuries through high-energy mechanisms including motor vehicle accidents, falls from significant heights, and sports-related trauma. The patient population is characterised by a strong female predominance (77%), with peak incidence occurring in women aged 80-89 years, though the bimodal pattern means younger adults are also significantly affected. These fractures account for 5-6% of all adult fractures.[9]

Treatment approaches vary considerably based on fracture pattern and patient factors. Conservative management through sling immobilisation remains appropriate for 80-85% of cases, particularly those with minimal displacement. However, surgical intervention rates differ markedly between trauma types, with 43.5% of high-energy fractures requiring operative treatment compared to 18.7% of low-energy fractures. Surgical options encompass percutaneous pinning for simpler patterns, open reduction and internal fixation (ORIF) for more complex cases, and arthroplasty procedures (hemiarthroplasty or reverse shoulder arthroplasty) for severely comminuted or displaced fractures in elderly patients. Early mobilisation protocols are crucial regardless of treatment method to prevent the significant shoulder stiffness that can complicate recovery.[9]

Distal Radius Fractures

X-ray image of a Colles fracture

The Colles fracture represents one of the most frequently encountered upper extremity injuries, typically resulting from a fall onto an outstretched hand (FOOSH) with the wrist in extension. This mechanism leads to the characteristic dorsal angulation and displacement of the distal radius fragment. The fracture pattern is particularly common in osteoporotic bone, reflecting the underlying bone quality in many affected patients. The patient demographics show a clear two-way distribution, with postmenopausal women aged 60-70 years representing the fragility fracture population, while young adults aged 20-40 years sustain these injuries through high-energy trauma. Colles fractures account for 10-25% of all adult fractures.[10]

Treatment decisions are guided primarily by fracture stability and displacement. Stable, minimally displaced fractures respond well to closed reduction and cast immobilisation, while unstable patterns may require percutaneous pinning to maintain reduction. Complex or unstable fractures, particularly those with intra-articular involvement, typically necessitate ORIF using volar locking plates, which have become the gold standard for surgical management. Severely comminuted fractures may require external fixation, particularly when significant bone loss or soft tissue injury complicates the clinical picture.[10][11]

Xray image of a Smith fracture

The Smith fracture (also known as reverse Colles fractures or Goyrand-Smith fracture) result from distinctly different mechanisms including falls onto a flexed wrist or direct dorsal blows to the wrist. This mechanism produces volar displacement of the distal radius fragment, creating an inherently unstable fracture pattern. Unlike Colles fractures, Smith fractures demonstrate less age-specific distribution and affect both genders more equally, though they remain more common in young adults involved in high-energy trauma. The relative rarity compared to Colles fractures belies their clinical significance, as they often present greater treatment challenges.[12]

The inherent instability of Smith fractures frequently requires surgical intervention, with closed reduction alone showing high failure rates. ORIF using volar locking plates has become the most common treatment approach, providing stable fixation that allows earlier mobilisation. The fracture pattern typically requires longer immobilisation periods than Colles fractures, and rehabilitation must account for the increased soft tissue involvement that often accompanies these injuries.[12]

Wrist and Hand Fractures

Xray image of scaphoid fracture

Scaphoid fractures predominantly affect young males aged 15-40 years, accounting for 60% of all carpal bone fractures with peak incidence in the second and third decades of life. Athletes, particularly those participating in contact sports, represent a significant portion of this patient population. The typical mechanism involves a FOOSH with the wrist extended and radially deviated, though direct blows to the radial aspect of the wrist and hyperextension injuries during sports activities also contribute to the injury pattern.[13]

Treatment approaches are largely determined by fracture location and displacement. Non-displaced fractures can be managed conservatively with cast immobilisation for 8-12 weeks, though this requires careful monitoring for healing progression. Displaced fractures with greater than 1mm separation typically require surgical fixation using headless compression screws to achieve and maintain reduction. The scaphoid bone has a unique blood supply distribution course: blood is supplied by a branch of the radial artery that enters at the distal side of the bone and then travels proximally in a retrograde fashion. Proximal pole fractures present particular challenges due to the retrograde blood supply of the scaphoid, often requiring surgical intervention even when minimally displaced. Non-union cases, which occur more frequently with scaphoid fractures than other carpal injuries, require bone grafting combined with internal fixation to achieve healing.[13]

The following optional video concisely describes the clinical implications of the retrograde blood supply of the scaphoid bone.

[14]

Xray image of radial head fracture

Radial head fractures typically occur through a FOOSH with the elbow flexed and forearm pronated, creating axial loading through the radius. These injuries predominantly affect adults aged 30-50 years with a slight female predominance and are often associated with elbow dislocations, complicating both initial assessment and treatment planning. Non-displaced fractures can be managed with early mobilisation in a sling, while displaced fractures require either ORIF or radial head replacement depending on the fracture pattern and patient factors. Severely comminuted fractures may necessitate radial head excision or prosthetic replacement, particularly when reconstruction is not feasible.[15]

Types of metacarpal fractures

Metacarpal fractures, particularly fifth metacarpal fractures commonly known as "boxer's fractures," predominantly affect young males aged 20-40 years through direct trauma mechanisms including punching injuries and crushing forces. The patient demographic often reflects involvement in altercations or contact sports, influencing both the injury pattern and subsequent compliance with treatment recommendations. Non-displaced fractures respond well to splinting, while unstable or significantly displaced fractures require surgical intervention through K-wire fixation or ORIF, with early mobilisation protocols initiated once fracture stability is achieved.[16]

Lower Extremity Fractures

Proximal Lower Extremity Fractures

Xray image of proximal femur (hip) fracture

Proximal hip fractures (intertrochanteric fracture, subtrochanteric or femoral neck fracture) represent one of the most devastating consequences of osteoporotic bone disease, presenting a major worldwide public health problem with a high socioeconomic burden. The mechanism predominantly involves low-energy trauma in older populations, with most hip fractures among older adults being fall-related. Falls from standing height or minimal trauma are sufficient to cause fracture in osteoporotic bone, while younger patients require high-energy mechanisms such as motor vehicle accidents or significant falls to sustain these injuries.[17]

The patient population demonstrates clear demographic patterns, with the incidence and number of hip fractures among patients aged 55 years and older having increased over the past three decades, indicating that the global burden of hip fracture remains substantial. Women are disproportionately affected due to postmenopausal bone loss, though hip fractures among males are perhaps underestimated, and older adults should receive greater attention. The peak incidence occurs in patients over 80 years, with institutional residents at particularly elevated risk due to multiple fall risk factors and compromised bone health.[17]

Treatment approaches prioritise early surgical intervention to reduce the significant morbidity and mortality associated with prolonged immobilisation. This type of injury has a high rate of morbidity and mortality, requiring surgical intervention to reduce these risks. Intracapsular fractures may be managed with internal fixation in younger patients or arthroplasty procedures (hemiarthroplasty or total hip arthroplasty/replacement) in older patients with poor bone quality. Extracapsular fractures typically receive intramedullary nail fixation or sliding hip screw devices depending on fracture pattern and patient factors. Post-operative rehabilitation focuses on early mobilisation, fall prevention strategies, and comprehensive bone health optimisation including osteoporosis treatment.[18]

Optional reading: please read this article on hip precautions

Xray image of a femoral shaft fracture

Femoral shaft fractures typically result from high-energy mechanisms in young adults or low-energy falls in elderly patients with osteoporotic bone. Treatment almost invariably requires intramedullary nailing to restore length, alignment, and rotation while allowing early mobilisation. The patient demographics reflect a similar two-way distribution seen with other fractures, though the high-energy nature means younger adults predominate.[19]

Xray image of a patellar fracture

Patellar fractures typically result from direct trauma to the anterior knee, such as dashboard injuries in a motor vehicle accident or a fall directly onto the patella. Indirect mechanisms involve powerful quadriceps contraction against resistance, creating transverse fractures through eccentric muscle loading. The fracture pattern significantly influences treatment decisions, with transverse fractures having greater displacement potential than vertical or comminuted patterns.[20]

The patient population includes younger adults involved in high-energy trauma and older adults sustaining fractures through falls. Athletes may sustain patellar fractures through jumping sports or direct contact injuries. Rare patellar stress fractures can be transverse or vertical, with transverse fractures carrying greater risk of displacement, often requiring immobilisation or surgical fixation.

Treatment depends on fracture displacement and pattern. Non-displaced fractures may be managed conservatively with cylinder casting and early range of motion exercises, while displaced fractures require surgical intervention to restore patellar alignment and maintain quadriceps function. Tension band wiring remains the gold standard for transverse fractures, though severely comminuted fractures may require partial or total patellectomy in extreme cases.[20]

Distal Lower Extremity Fractures

Xray image of a fibular fracture

Many factors contribute to the development of fibular fractures including changes in athletic training, specific anatomic features, decreased bone density, and diseases. Mechanisms range from direct trauma to the lateral leg to indirect rotational forces transmitted through the ankle joint. Fractures of the fibula sometimes occur with severe ankle sprains, and the fracture can happen anywhere along the fibula. Isolated fibular shaft fractures may result from direct blows during contact sports or motor vehicle accidents, while fractures involving the distal fibula typically occur through the ankle injury mechanisms.[21]

Patient populations vary considerably based on fracture location and mechanism. Proximal fibular fractures often affect older adults through falls or younger individuals through sports trauma, while distal fibular fractures as part of ankle injuries show the demographic patterns previously described. Isolated fibular shaft fractures are more common in active individuals participating in contact sports or those involved in traumatic accidents.

Treatment depends on fracture location, displacement, and associated injuries. Isolated, non-displaced fibular shaft fractures may be managed conservatively with weight-bearing as tolerated, as the fibula bears minimal load compared to the tibia. However, displaced fractures or those associated with ankle instability require surgical fixation to restore length and alignment. Distal fibular fractures forming part of ankle injuries follow the treatment principles outlined for ankle fractures, with surgical intervention typically required to restore the ankle mortise.[21]

Xray image of a tibial plateau fracture

Tibial plateau fractures result from axial loading forces combined with valgus or varus stress, commonly occurring during motor vehicle accidents, falls from height, or high-energy sports injuries. The mechanism typically involves compression of the femoral condyle against the tibial plateau, creating depression or split-depression fracture patterns. Low-energy mechanisms in elderly patients with osteoporotic bone can produce significant fractures with minimal trauma, particularly affecting the lateral plateau which bears greater loads during normal ambulation.[22]

The patient demographics show a bimodal distribution similar to other fractures, with high-energy trauma affecting younger adults (typically 20-40 years) and low-energy mechanisms causing fractures in older adults over 60 years. While minimal tibial plateau fractures with no associated injuries can be safely managed non-operatively, typically this injury requires orthopaedic consultation and operative management. The complexity of these fractures often relates to associated soft tissue injuries, including meniscal tears, ligament disruptions, and vascular compromise.

Treatment priorities focus on restoring joint congruity and stability to prevent post-traumatic arthritis. The goal of therapy is to reduce the fracture and begin early mobilisation, with ORIF being the current gold standard. Conservative management is reserved for non-displaced fractures in elderly patients with significant medical comorbidities. Surgical approaches may include percutaneous techniques for simple patterns or formal open reduction with bone grafting for complex depression fractures. If the patient is immobilised for a lengthy period (>3 weeks), the joint will not return to full range of movement, emphasising the importance of early mobilisation protocols.[22]

Tibial shaft fractures demonstrate varied mechanisms from high-energy trauma to stress fractures in athletes. Treatment ranges from conservative management in stable patterns to surgical intervention with intramedullary nailing or plate fixation for displaced or unstable fractures. The subcutaneous location of the tibia creates particular challenges with wound healing and infection risks.[23]

Foot and Ankle Fractures, and Associated Ligament Injuries

Xray image of ankle fracture

Ankle fractures are common injuries that result from a range of mechanisms, from trivial twisting in frail adults up to high-energy trauma in young populations. The mechanism often involves rotational forces applied to a planted foot, creating patterns that frequently combine fracture and ligament injury. External rotation injuries may produce lateral malleolar fractures with medial deltoid ligament disruption, while eversion mechanisms can cause medial malleolar fractures with lateral ligament complex injury.[24] Research suggests an incidence rate of ankle fractures of 4.22/10,000 person-years.[25]

The relationship between ankle fractures and ligament injuries is crucial for rehabilitation professionals to understand, as the stability of the ankle mortise depends on both bony and ligamentous structures. Syndesmotic injuries may accompany ankle fractures, particularly with external rotation mechanisms, and the injury mechanism of syndesmotic injury may include external rotation of the foot, eversion of the talus and excessive dorsiflexion. Pure ligament injuries (ankle sprains) share similar mechanisms but occur when the applied force is insufficient to cause fracture or when the ligament fails before the bone.[26]

Treatment of ankle fractures aims to restore joint alignment and stability to reduce the risk of post-traumatic ankle arthritis. Stable, minimally displaced fractures may be managed conservatively with immobilisation, while unstable patterns require surgical fixation with plates and screws. The presence of associated ligament injury influences treatment decisions and rehabilitation protocols, as ligamentous healing typically requires longer protection periods than bony union. Combined fracture-dislocations represent surgical emergencies requiring immediate reduction and fixation to prevent soft tissue complications.[26]

Xray image of talus fracture

Talus fractures are significant injuries that typically result from high-energy axial loading mechanisms. Motor vehicle accidents, falls from height, and snowboarding injuries represent the most common causes. The mechanism often involves forced dorsiflexion of the foot against a fixed object, creating fractures through the talar neck, which is the most common location. The talus has a precarious blood supply with multiple watershed areas, making these fractures prone to complications including avascular necrosis and non-union.[27]

The patient demographics reflect the high-energy nature of most talar fractures, with young to middle-aged adults most commonly affected. Males predominate due to higher participation in high-risk activities and occupations. The location of fracture within the talus (neck, body, or head) influences both treatment and prognosis, with talar neck fractures being most common but carrying the highest risk of avascular necrosis.

Treatment requires urgent anatomical reduction and stable fixation to minimise complications. Non-displaced talar neck fractures may be managed with non-weight-bearing immobilisation, but most require surgical intervention with screw fixation. Displaced fractures constitute orthopaedic emergencies requiring immediate reduction to prevent skin necrosis and optimise blood supply. Post-operative management involves prolonged non-weight-bearing periods (often 8-12 weeks) due to the risk of avascular necrosis and collapse.[27]

Xray image of calcaneus fracture

Calcaneal fractures usually result from axial loading mechanisms such as falls from height, affecting predominantly young to middle-aged males in occupational or recreational settings. These complex fractures often require surgical reconstruction to restore heel alignment and subtalar joint congruity, with prolonged rehabilitation periods due to the weight-bearing nature of the calcaneus.[28]

Xray image of 5th metatarsal fracture

Metatarsal stress fractures represent overuse injuries resulting from repetitive loading that exceeds the bone's adaptive capacity. The mechanism involves cumulative microtrauma from activities such as running, dancing, or military training, with the second and third metatarsals most commonly affected due to their role in weight-bearing and push-off phases of gait. Risk factors include training errors, biomechanical abnormalities, nutritional deficiencies, and hormonal factors affecting bone metabolism.[29]

The patient population predominantly consists of athletes, military recruits, and individuals participating in high-impact activities. Female athletes show higher incidence rates due to factors including lower bone density, nutritional issues, and hormonal influences affecting bone health. Runners, ballet dancers, and basketball players represent high-risk populations due to repetitive forefoot loading patterns in their activities.[29]

Treatment emphasises activity modification and graduated return to sport protocols. Early-stage stress reactions may respond to relative rest and cross-training activities, while established fractures typically require 6-8 weeks of modified weight-bearing. Complete fractures or those in high-risk locations (fifth metatarsal base, navicular) may require surgical intervention with internal fixation. Prevention strategies focus on appropriate training progression, biomechanical assessment, and addressing modifiable risk factors including nutrition and bone health.[30]

Spinal Fractures

To learn more about the AO surgical reference system used on this page, please refer to this website. The following optional video further explains the AO surgical reference system and different spinal fracture types.

[31]

Thoracolumbar compression fractures represent the most common osteoporotic fractures and constitute a major clinical and public health challenge worldwide. Typically occurring due to biomechanical failure under axial or compressive loading, these fractures predominantly involve the anterior column of the vertebral body, usually resulting in a characteristic wedge-shaped deformity. The mechanism involves flexion-compression forces that exceed the bone's ability to withstand axial loads, with the anterior portion of the vertebral body collapsing while the posterior elements remain intact. In osteoporotic patients, minimal trauma such as coughing, sneezing, or lifting light objects may be sufficient to cause fracture, while younger patients typically require higher energy mechanisms such as falls from height or motor vehicle accidents.[32]

The patient population demonstrates a strong predominance towards elderly individuals, particularly postmenopausal women over 65 years where osteoporosis significantly reduces bone density and strength. Compression/AO type A1 fractures account for 33.60% (±15.10) of thoracolumbar fractures, making them the second most common thoracolumbar injury pattern. The thoracolumbar junction (T12-L2) represents the most frequent location due to the transition from the rigid thoracic spine to the more mobile lumbar spine, creating a biomechanical stress concentration point.[33]

Treatment approaches are largely determined by fracture stability, neurological involvement, and patient factors. Most stable compression fractures with minimal deformity can be managed conservatively with pain management, activity modification, and bracing if indicated. Progressive kyphotic deformity, severe pain, or neurological compromise may warrant surgical intervention through vertebroplasty or kyphoplasty procedures, which involve injecting cement into the fractured vertebral body to restore height and provide pain relief. Severe cases with significant spinal canal compromise may require decompression and fusion procedures, though this is uncommon in simple compression fractures.[32]

Burst/AO type A3 fractures were the most common morphology at 39.50% (±16.30) of thoracolumbar fractures, representing the most frequently encountered traumatic spinal injury pattern. The mechanism involves high-energy axial loading that causes failure of both the anterior and middle columns of the spine, resulting in comminution of the vertebral body with potential retropulsion of bone fragments into the spinal canal. Unlike compression fractures, burst fractures involve the posterior cortex of the vertebral body and may compromise spinal stability through disruption of the middle column.[34]

The patient demographics reflect the high-energy nature of these injuries, with young to middle-aged adults most commonly affected through motor vehicle accidents, falls from significant heights, diving injuries, or industrial accidents. Males predominate due to higher participation in high-risk activities and occupations. The thoracolumbar junction remains the most common location, with L1 being the single most frequently fractured vertebra due to its position at the apex of the normal lumbar lordosis.

Treatment decisions depend on several factors including neurological status, degree of canal compromise, kyphotic angulation, and overall spinal stability. Neurologically intact patients with stable fracture patterns and minimal canal compromise may be managed conservatively with bracing and activity restrictions, though this requires careful monitoring for progressive deformity. Patients with neurological deficits, significant canal compromise (>50%), or progressive kyphotic deformity typically require surgical intervention through posterior instrumentation and fusion, with anterior reconstruction reserved for cases with significant anterior column loss. Early mobilisation and rehabilitation are crucial to prevent complications and optimise functional outcomes.[34]

Flexion-Distraction Injuries (also known as Chance fracture or seatbelt fractures) is an unstable spine fracture that typically occurs at the thoracolumbar junction. It is a horizontal fracture extending from posterior to anterior through the spinous process, pedicles, and vertebral body. One can overlook Chance fractures on clinical exam because patients rarely present with a neurological deficit. However, the incidence of concurrent intra-abdominal injuries can be as high as 50%.[35]

The mechanism typically involves sudden deceleration with the spine acting as a fulcrum around a fixed point, most commonly a seatbelt in motor vehicle accidents. The hyperflexion force creates tension failure extending from the posterior elements through to the anterior vertebral body, resulting in a horizontal split through all three spinal columns. Flexion distraction/AO type B fractures represent 6.96% (±3.50) of thoracolumbar fractures, though their clinical significance exceeds their frequency due to associated injuries and potential for delayed recognition.

The patient population predominantly consists of motor vehicle occupants involved in high-speed deceleration accidents, particularly those wearing lap-belt restraints without shoulder straps. Both children and adults can be affected, though the mechanism varies slightly with children more prone to purely ligamentous injuries due to greater spinal flexibility. The high association with intra-abdominal injuries requires comprehensive trauma evaluation, as visceral injuries may be life-threatening and initially overshadow the spinal injury.

Treatment almost invariably requires surgical stabilisation due to the inherent instability of these injuries. Posterior instrumentation and fusion is the standard approach, extending from one level above to one level below the injury. The posterior approach allows correction of any kyphotic deformity while providing stable internal fixation. Conservative management is rarely appropriate due to the high risk of progressive deformity and potential neurological deterioration. Early recognition and treatment are crucial as delayed diagnosis significantly impacts clinical outcomes.[35]

Fracture dislocation/AO type C injuries account for 14.20% (±8.08) of thoracolumbar fractures, representing the most severe and unstable spinal injury pattern. The mechanism involves failure of all three spinal columns with significant translation or rotation between vertebral segments, typically resulting from extreme force vectors combining flexion, extension, rotation, and distraction. These injuries represent complete mechanical disruption of spinal stability with inevitable neurological involvement due to severe spinal cord compression or transection.[36]

The patient demographics reflect the extreme energy required to produce these injuries, with young adults most commonly affected through motor vehicle accidents, motorcycle crashes, falls from great heights, or penetrating trauma. The neurological consequences are typically severe, with complete or incomplete spinal cord injuries being the norm rather than the exception. The psychological and social impact of these injuries extends far beyond the mechanical aspect, often resulting in permanent disability requiring comprehensive rehabilitation and long-term care.

Treatment priorities focus on spinal cord decompression, restoration of spinal alignment, and rigid stabilisation to prevent further neurological deterioration. Emergency surgical intervention is typically required through combined anterior and posterior approaches to address the complex three-column instability. Anterior reconstruction may be necessary to restore vertebral body height and decompress neural elements, while posterior instrumentation provides the primary stabilisation. The extent of surgical intervention depends on the specific fracture pattern, degree of instability, and neurological status, though aggressive surgical management is typically warranted given the severity of these injuries.[36]

Optional reading: please read this journal article to learn about recommended rehabilitation interventions and bracing options for patients following cervical and lumbar surgeries.

Resources

Optional Additional Reading

Osteoporosis significantly increases fracture risk through reduced bone density and deteriorated microarchitecture, with fragility fractures resulting from low-energy trauma such as falls from standing height. This systemic condition predominantly affects postmenopausal women and creates a cascade effect where each fracture increases subsequent fracture risk. The following Physiopedia Pages provide more in-depth information on this and related topics to help deepen understanding on fracture formation.

References

  1. ↑ Zhang YY, Xie N, Sun XD, Nice EC, Liou YC, Huang C, Zhu H, Shen Z. Insights and implications of sexual dimorphism in osteoporosis. Bone research. 2024 Feb 18;12(1):8.
  2. ↑ 2.0 2.1 2.2 International Osteoporosis Foundation. Fragility Fractures Epidemiology. Available from: https://www.osteoporosis.foundation/health-professionals/fragility-fractures/epidemiology (accessed 25/August/2025).
  3. ↑ World Health Organization. Injuries and violence. Available from: https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence (accessed 25/August/2025).
  4. ↑ Khan AA, Slart RH, Ali DS, Bock O, Carey JJ, Camacho P, Engelke K, Erba PA, Harvey NC, Lems WF, Morgan S. Osteoporotic fractures: diagnosis, evaluation, and significance from the International Working Group on DXA Best Practices. InMayo clinic proceedings 2024 Jul 1 (Vol. 99, No. 7, pp. 1127-1141). Elsevier.
  5. ↑ Rizzo S, Kenan S. Pathologic Fractures [Internet]. 2023 [cited 25/August/2025]. Available from:https://www.ncbi.nlm.nih.gov/books/NBK559077/
  6. ↑ Warden SJ, Burr DB, Brukner PD. Stress fractures: pathophysiology, epidemiology, and risk factors. Current osteoporosis reports. 2006 Sep;4(3):103-9.
  7. ↑ Bentley T, Hosseinzadeh S. Clavicle Fracture [Internet]. 2023 [cited 31/August/2025]. Available from:https://www.ncbi.nlm.nih.gov/books/NBK507892/
  8. ↑ Qvist AH, Jensen SL. Minimal early functional gains after operative treatment of midshaft clavicular fractures: a meta-analysis of 10 randomized controlled trials including 1333 patients. JSES international. 2024 May 1;8(3):400-6.
  9. ↑ 9.0 9.1 Attum B, Thompson JH. Humerus Fractures Overview [Internet]. 2023 [cited 31/August/2025]. Available from:https://www.ncbi.nlm.nih.gov/books/NBK482281/
  10. ↑ 10.0 10.1 Summers K, Mabrouk A, Fowles SM. Colles Fracture [Internet]. 2023 [cited 31/August/2025]. Available from:https://www.ncbi.nlm.nih.gov/books/NBK553071/
  11. ↑ Haslhofer DJ, Froschauer SM, Gotterbarm T, Schmidt M, Kwasny O, Holzbauer M. Comparison of surgical and conservative therapy in older patients with distal radius fracture: a prospective randomized clinic al trial. Journal of Orthopaedics and Traumatology. 2024 Oct 1;25(1):46.
  12. ↑ 12.0 12.1 Schroeder JD, Varacallo MA. Smith Fracture Review [Internet]. 2024 [cited 31/August/2025]. Available from:https://www.ncbi.nlm.nih.gov/books/NBK547714/
  13. ↑ 13.0 13.1 Hayat Z, Varacallo MA. Scaphoid Wrist Fracture [Internet]. 2023 [cited 31/August/2025]. Available from:https://www.ncbi.nlm.nih.gov/books/NBK536907/
  14. ↑ YouTube. Scaphoid blood supply | Clinical Physio. Available from: https://www.youtube.com/shorts/w9IFVH0TR5c [last accessed 01/September/2025]
  15. ↑ Patiño JM, Saenz VP. Radial Head Fractures [Internet]. 2023 [cited 31/August/2025]. Available from:https://www.ncbi.nlm.nih.gov/books/NBK448140/
  16. ↑ Werntz RL, Varacallo MA. Metacarpal Fracture [Internet]. 2023 [cited 31/August/2025]. Available from:https://www.ncbi.nlm.nih.gov/books/NBK551532/
  17. ↑ 17.0 17.1 Feng JN, Zhang CG, Li BH, Zhan SY, Wang SF, Song CL. Global burden of hip fracture: the global burden of disease study. Osteoporosis international. 2024 Jan;35(1):41-52.
  18. ↑ Emmerson B, Varacallo MA, Inman D. Hip Fracture Overview [Internet]. 2023 [cited 31/August/2025]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557514/
  19. ↑ Denisiuk M, Afsari A. Femoral Shaft Fractures [Internet]. 2023 [cited 31/August/2025]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556057/
  20. ↑ 20.0 20.1 Luo TD, Marino DV, Pilson H. Patella Fractures [Internet]. 2023 [cited 31/August/2025]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513330/
  21. ↑ 21.0 21.1 Walters BB, Constant D, Anand P. Fibula Fractures [Internet]. 2023 [cited 31/August/2025]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556139/
  22. ↑ 22.0 22.1 Malik S, Herron T, Mabrouk A, Rosenberg N. Tibial Plateau Fractures [Internet]. 2023 [cited 31/August/2025]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470593/
  23. ↑ Thompson JH, Koutsogiannis P, Jahangir A. Tibia Fractures Overview [Internet]. 2023 [cited 31/August/2025]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513267/
  24. ↑ Wang Y, Wang Z, Chen B, Chen B, Fang R, Zeng H, Peng J, Gao Y, Hao L. Global epidemiology of lower limb fractures: Trends, burden, and projections from the GBD 2021 study. Bone. 2025 Apr 1;193:117420.
  25. ↑ Wu AM, Bisignano C, James SL, Abady GG, Abedi A, Abu-Gharbieh E, Alhassan RK, Alipour V, Arabloo J, Asaad M, Asmare WN. Global, regional, and national burden of bone fractures in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. The Lancet Healthy Longevity. 2021 Sep 1;2(9):e580-92.
  26. ↑ 26.0 26.1 Hermena S, Slane V. Ankle Fracture [Internet]. 2025 [cited 31/August/2025]. Available from:https://www.ncbi.nlm.nih.gov/books/NBK542324/
  27. ↑ 27.0 27.1 Russell TG, Byerly DW. Talus Fracture [Internet]. 2025 [cited 31/August/2025]. Available from:https://www.ncbi.nlm.nih.gov/books/NBK539687/
  28. ↑ Davis D, Seaman TJ, Newton EJ. Calcaneus Fractures [Internet]. 2025 [cited 31/August/2025]. Available from:https://www.ncbi.nlm.nih.gov/books/NBK430861/
  29. ↑ 29.0 29.1 May T, Marappa-Ganeshan R. Stress Fractures [Internet]. 2023 [cited 31/August/2025]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554538/
  30. ↑ Agrawal U, Tiwari V. Metatarsal Fractures [Internet]. 2023 [cited 31/August/2025]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK574512/
  31. ↑ YouTube. AO Classification Thoracolumbar Fractures | Brain, Spine and Beyond. Available from: https://www.youtube.com/watch?v=tomY1BIbwEs [last accessed 31/August/2025]
  32. ↑ 32.0 32.1 Fernández-de Thomas RJ, De Jesus O.Metatarsal Fractures [Internet]. 2023 [cited 31/August/2025]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562204/
  33. ↑ Donnally III CJ, Margetis K, Varacallo MA. Vertebral Compression Fractures [Internet]. 2025 [cited 31/August/2025]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448171/
  34. ↑ 34.0 34.1 Whitney E, Alastra AJ. Vertebral Fracture [Internet]. 2023 [cited 31/August/2025]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547673/
  35. ↑ 35.0 35.1 Koay J, Davis DD, Hogg JP. Chance Fractures [Internet]. 2023 [cited 31/August/2025]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536926/
  36. ↑ 36.0 36.1 Kumar S, Patralekh MK, Boruah T, Kareem SA, Kumar A, Kumar R. Thoracolumbar fracture dislocation (AO type C injury): A systematic review of surgical reduction techniques. Journal of Clinical Orthopaedics and Trauma. 2020 Sep 1;11(5):730-41.
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