Compound Fracture is an unlockable passive item added in Afterbirth †.
- Tears turn into bones, which shatter into 1-3 shards upon hitting an obstacle or enemy.
- Shards deal 50% of Isaac's normal tear damage.
- Unlike The ParasiteIsaac's tears split in two when they hit something., there is no damage minimum on splitting, but the tears can also split only once.
- +1.5 range.
- +1.0 tear height.
- Bob's Rotten HeadUpon use, Isaac holds a poison bomb which can be thrown towards any of the four cardinal points and explodes on impact.: The bomb will break into 1-3 more bombs which are launched in random directions from the point of impact.
- Cricket's BodyGrants -1 Tear Delay and reduces Range. When tears hit an object or deplete their range, they spawn 4 smaller tears, whose Range and Damage scale with Isaac's./ The ParasiteIsaac's tears split in two when they hit something.: Each tear splits into more tears, which will all shatter.
- HaemolacriaTears are now fired in an arc. Upon hitting the floor, an obstacle, or an enemy, they burst into many smaller tears in all directions. Increases tear delay.: Tears will sometimes burst into smaller tears when hitting obstacles or enemies. These smaller tears are basically miniature Haemolacria tears, which will burst when hitting the ground.
- IpecacReplaces tears with explosive and poisoning projectiles fired in an arc from the mouth.: If the bone tear hits a wall or an obstacle, it will split into explosive half-damage shards. Hits on enemies and the floor behave as normal Ipecac.
- The Ludovico TechniqueInstead of firing tears, Isaac controls one floating tear that hover over obstacles. This tear deals constant damage when held in place over an enemy.: Tear turns into a spinning bone that rapidly spews out smaller bone shots on contact with enemies.
- Spectral Tears: Bones pass through obstacles and generate shards for each obstacle they pass through, which can result in many shards being generated from a single bone.
- Anti-Gravity-2 Tear Delay. Tears float in position until firing ceases, after which they will fly off in the direction they were shot in.: Bone tears will hover until released but bone shards will travel normally.
- BrimstoneTears are replaced by a laser beam that pierces through all enemies and obstacles in its path and deals high damage. Can only be fired after a short charge-up period.: Overrides Compound Fracture.
- Dr. FetusTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired.: Overrides Compound Fracture.
- Epic FetusIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote.: Overrides Compound Fracture.
- Flat StoneTears bounce off the floor. Tears that hit an enemy after bouncing deal splash damage to all nearby enemies for 25% of Isaac's tear damage.: Bone tears will bounce when they are fired, however, bone shards will not bounce when they travel.
- LachryphagyIsaac's tears decelerate as they travel. Upon stopping or hitting an obstacle, they burst into 8 tears in all directions. Tears can be fired into other tears to feed them, increasing their damage.: Bone tears can be fed and will burst into split tears. Bone tears will burst into bone shards when hitting obstacles or enemies which can also be fed and burst into split tears and bone shards yet again. When bone shards are fed, they turn back into bone tears which can repeat this process again and again.
- Mom's KnifeIsaac's tears are replaced by a knife that pierces enemies, can travel through obstacles, and can hurt enemies while Isaac is holding it. Holding down the fire button before firing increases its range and power.: Overrides Compound Fracture.
- TechnologyReplaces tears with a piercing laser with unlimited range./ Tech XTears are replaced with laser rings that pierce through enemies and deal damage to enemies within them. Can be charged to increase the size of the ring.: Overrides Compound Fracture.
- Technology 2Decreases damage and replaces right eye tears with a unlimited range, piercing laser which fires continuously.: The laser is not affected, but bone tears still shoot from Isaac's left eye.
- Tractor BeamIsaac emits a beam from his face. Isaac's tears travel in the path of the beam.: Bone tears will not burst into bone shards when fired at obstacles, however, bone tears will burst into bone shards when fired at enemies.
- TrisagionTears are replaced with piercing white blasts of light.: Beams will only burst when hitting obstacles.
- The item is a reference to a compound fracture, a medical condition where a bone breaks and is exposed through the skin.
- Brittle BonesReplaces all red hearts with 6 empty bone hearts. Upon losing a bone heart, Isaac fires bones in 8 directions and permanently gains a tears up.
- Compound FractureIncreases range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle.
- Dead ToothWhile firing, Isaac gains a green aura that poisons nearby enemies.
- Dog ToothIncreases damage and speed. Upon entering a room adjacent to a secret room, a howl sound effect will play.
- Jaw BoneSpawns a familiar that flies the room while firing, dealing a flat 7 damage to enemies that come in contact and retrieving pickups.
- MarrowGrants one bone heart and spawns three red heart pickups.
- Monstro's ToothMonstro jumps onto a random enemy, doing area damage. Can damage/kill the player if summoned in an room without enemies.
- My Little UnicornUpon use, grants invulnerability and increased speed for five seconds, removing the ability to shoot tears and replacing it with the ability to deal contact damage to enemies.
- Pointy RibSpawns a bone familiar that can be aimed with the fire buttons and does contact damage.
- Slipped RibSpawns a bone familiar that circles around Isaac and reflects enemy shots.
- Unicorn StumpUpon use, grants invulnerability and increased speed for five seconds, but removes the ability to shoot tears.