2.) Types of Fractures Flashcards
What type of fracture (fx) is pictured?
Type I: Epiphyseal Fracture
6%
- Pure epiphyseal separation that may widen the growth plate
- Difficult to assess
- Need comparison x-rays: Look for soft tissue swelling
- Shearing or avulsive forces
- Location: Proximal humerus & femur, distal humerus
What type of fracture (fx) is pictured?
Greenstick Fx aka Hickory Stick Fx
Incomplete Fracture: Occurs primarily in infants & children under the age of 10
- Bone bends:
- Tension on convex side
- Produces a transverse fracture
- Concave side remains intact
- Incomplete Fx: Fractures which typically involves only one cortex often resulting in angulation or buckling
What type of fracture (fx) is pictured?
Impaction Fx
A portion of bone driven into adjacent segment so the bone collapses into itself
- A subtle radiopaque white line is seen in the region of the impaction
- Radiolucent fracture line is seldom visualized
- 2 Subtypes:
- Depressed
- Compression
What type of fracture (fx) is pictured?
Non-Union Fx
Failure to complete osseous fusion across the fracture site
- Fracture rounding
- Lack of callus
- Sclerosis
- Pseudoarthrosis
- Locations: Midclavicle, ulna, tibia
What type of fracture (fx) is pictured?
Transverse Fx
Runs at a right angle to the long axis of a bone
- Common
- Can occur in healthy bone but frequently seen in diseased bone so always look closely for underlying pathology
What type of fracture (fx) is pictured?
Spiral Fx
Created by torsion coupled with axial compression & angulation
- Ends of a spiral fracture are pointed like an ink well pen
What type of fracture (fx) is pictured?
Compression Fx
- Vertebral Body
- Anterior wedging of the vertebral body
- Step defect
- Zones of condensation aka zones of impaction
- Last 2 disappear within 2 months of the fracture
What type of fracture (fx) is pictured?
Complete, Non-Comminuted Fx
A single fracture that extends from one cortex to the other
What types of fractures (fx) are pictured?
Salter-Harris Fx aka Growth Plate Fx aka Epiphyseal Fx
- Type I (6%): Pure epiphyseal separation that may widen growth plate
- Type II (75%): Fracture through physis & portion of metaphysis
- Type III (8%): Fracture through physis & epiphysis
- Type IV (10%): Fracture contains both metaphyseal & epiphyseal fragments
- Type V (1%): Compressive force crushes physis & injures vascular supply & germinal cells
What type of fracture (fx) is pictured?
Pseudofractures aka Looser’s Zones aka Umbau Zonen aka Milkman’s Syndrome aka Increment Fx
- Can be due to vascular pulsations
- Discrete regions of uncalcified osteoid
- On convex side of lone bones at 90° to long axis of the bone
- Multiple
- Associated with bone softening disorders
- Paget’s Disease, Rickets, Osteomalacia, FD, Osteogenesis Imperfecta
What type of fracture (fx) is pictured?
Impaction Fx
A portion of bone driven into adjacent segment so the bone collapses into itself
- A subtle radiopaque white line is seen in the region of the impaction
- Radiolucent fracture line is seldom visualized
- 2 Subtypes:
- Depressed
- Compression
What type of fracture (fx) is pictured?
Multiple Fxs
More than one complete, non-cominuted fracture in the same bone
What type of fracture (fx) is pictured?
Open Fx with Reduction
- Closed Fx: Does not penetrate the skin
- Open Fx: Penetrates the skin opening the underlying tissue to the external environment
What type of fracture (fx) is pictured?
Type III: Epiphyseal Fracture (Fx)
8%
- Fracture through physis & epiphysis
- MC: 10-15 years
- Locations: medial or lateral distal tibia, proximal tibia, distal femur,
- Minimal displacement
- Arrest deformity rare
What complication of fracture is pictured?
Infection
Complicating infection
What type of fracture (fx) is pictured?
Chip Fx aka Corner Fx
A form of avulsion fracture that is usually limited to the separation of a small chip of bone from the corner of a phalanx or other short or long tubular bone
What feature of the reparative or metabolic phase of fracture repair is pictured?
Clinical Union Callus
Sufficient callus to allow weight bearing or similar stress
What type of fracture (fx) is pictured?
Non-Union Fx
Failure to complete osseous fusion across the fracture site
- Fracture rounding
- Lack of callus
- Sclerosis
- Pseudoarthrosis
- Locations: Midclavicle, ulna, tibia
What type of fracture (fx) is pictured?
Stress Fx aka Fatigue Fx
- Can occur in normal or abnormal bone subjected to cyclic loading
- Only seen on x-ray only when signs of healing (callus) are present
- Often weeks into the process
What type of fracture (fx) is pictured?
Impaction Fx
A portion of bone driven into adjacent segment so the bone collapses into itself
- A subtle radiopaque white line is seen in the region of the impaction
- Radiolucent fracture line is seldom visualized
- 2 Subtypes:
- Depressed
- Compression
Which of the 3 phases of fracture repair is pictured?
Reparative or Metabolic Phase
- Buttressing Callus: Adjacent to outer surface of cortex & formed by periosteum & surrounding musculature
- Sealing Callus: Fills the medullary cavity & arises from the marrow to “seal” it from the fracture site
- Bridging Callus: Unites the gap between two buttress ends
- Uniting Callus: Joins the cortical portions of the fractured bones
- Clinical Union Callus: Sufficient callus to allow weight bearing or similar stress
What type of fracture (fx) is pictured?
Type II: Epiphyseal Fx
75%
- Thurston-Holland Sign aka Corner Sign: Fracture through physis & portion of metaphysis
- Shearing/avulsive forces
- Periosteum remains intact on the side of the metaphyseal fracture
- Helps with reduction
- Good prognosis
- MC: 10-16 years
- Locations: Distal radius (50%), tibia, fibula, femur, ulna
What type of fracture (fx) is pictured?
Burst Fx
Retropulsion indicates a burst fx
What type of fracture (fx) is pictured?
Avulsion Fx
Tearing away of a portion of the bone by a forceful muscular or ligamentous pulling
- Locations: Tuberosities, spinous processes of the lower cervical spine
What type of fracture (fx) is pictured?
Buckling Fx aka Torus Fx
Imcomplete Fx: “to bulge” latin
- Compression forces cause the cortex to bulge outward
- Most occur at the metaphysis
- Painful variety of greenstick fx
What type of fracture (fx) is pictured?
Complete, Comminuted Fx
A fracture from which 2 or more bony fragments have separated
- Classic Sign: A complete fracture in which multiple fractures intersect one another
What type of fracture (fx) is pictured?
Oblique Fx
Typically occurs at the shaft of the long tubular bone & its course is approximately 45° to the long axis of the bone
What type of fracture (fx) is pictured?
Stress Fx aka Fatigue Fx
- Can occur in normal or abnormal bone subjected to cyclic loading
- Only seen on x-ray only when signs of healing (callus) are present
- Often weeks into the process
What condition is pictured?
Bone Bruise
- Only seen on MRI
- Represents micro-fracture
- Around articular surfaces can act as a “map of the injury”
What type of fracture (fx) is pictured?
Transverse Fx
Runs at a right angle to the long axis of a bone
- Common
- Can occur in healthy bone but frequently seen in diseased bone so always look closely for underlying pathology
What type of fracture (fx) is pictured?
Greenstick Fx aka Hickory Stick Fx
Incomplete Fracture: Occurs primarily in infants & children under the age of 10
- Bone bends:
- Tension on convex side
- Produces a transverse fracture
- Concave side remains intact
- Incomplete Fx: Fractures which typically involves only one cortex often resulting in angulation or buckling
What type of fracture (fx) is pictured?
Non-Union Fx with Accessory Joint
Failure to complete osseous fusion across the fracture site
- Fracture rounding
- Lack of callus
- Sclerosis
- Pseudoarthrosis
- Locations: Midclavicle, ulna, tibia
What type of fracture (fx) is pictured?
Type IV: Epiphyseal Fx
10%
- Fx contains both metaphyseal & epiphyseal fragments
- MC locations:
- < 10 years: Lateral condyle of the humerus
- > 10 years: Tibia
- Vertically oriented spitting force
- Requires immediate open reduction & alignment to prevent growth arrest, joint deformity
- Guarded prognosis
- MCC of premature partial closure of the physis
Which of the 3 phases of fracture repair is pictured?
Circulatory or Inflammatory Phase
10 days
- Cellular phase
- Vascular phase
- Primary callus formation
What type of fracture (fx) is pictured?
Avulsion Fx
Tearing away of a portion of the bone by a forceful muscular or ligamentous pulling
- Locations: Tuberosities, spinous processes of the lower cervical spine
What type of fragment is pictured?
Butterfly Fragment
An isolated, triangular cortical fragment in a complete, cominuted fracture
- Usually found on the concave sid eof injury
What type of fracture (fx) is pictured?
Buckling Fx aka Torus Fx
Imcomplete Fx: “to bulge” latin
- Compression forces cause the cortex to bulge outward
- Most occur at the metaphysis
- Painful variety of greenstick fx
