Acral trauma

Question 1

Salter Harris Classification 
Type 1
2?
3, 4, 5?
Physis is the growth plate
Epiphysis is the heads of the bone 
Metaphysis 
The metaphysis is the wide portion of a long bone between the epiphysis and the narrow diaphysis

Answer 1

A. Type I:
- physis only
B. Type II:
- physis with metaphyseal fragment
- most common type
C. Type III:
- physis with epiphysis
D. Type IV:
- physis, metaphysis, and epiphysis
E. Type V:
- impaction of the physis
pg 7 radio notes

Question 2

Fracture healing:

What are the 3 phases?

Answer 2

1. Inflammatory (30 days)
   which has 3 sub phases: cellular (10 days), vascular (10 days), primary callus (10days)
   a) hematoma and clot formation (hematoma should not be disturbed)
   a2. inflammatory response and granulation tissue
   b1. formation of vascular spindle leads to hyperemia
   b2. increased osteoclastic activity from hyperemia
   c1. primary callus formation begins (usually not visible on x-ray at this stage) c2. fracture line becomes hazy, widens
2. Reparative (weeks)
   a. more order to callus formation
   b. different types of callus appear: sealing,
   buttressing, bridging, uniting
   c. osteoid replaced with more mature bone
   d. fractures usually stable by the end of this
   stage
3. Remodeling (months to yrs)
   a. new bone laid down along lines of stress
   b. unnecessary bone removed
   c. marrow cavity restored
   d. x-rays may be normal, but bone scans may still be warm

Question 3

What are the factors that modify healing?

Answer 3

1. Underlying conditions:
   - diseased bone, systemic conditions
2. Location:
   - flat and irregular bones take longer to heal than tubular bones
   - the mandible heals the slowest
3. Patient age:
   - the older the patient, the longer the healing time
4. Type of injury:
   - simple, non-comminuted, non-displaced fractures heal quickly - complicated fractures take longer to heal

Question 4

What are the complications of Trauma?

1. Immediate (hours)
2. Intermediate (days to weeks)’
3. Delayed (months to years)

Answer 4

Immediate (hours)

• vascular injury
• compartment syndrome
• fat emboli/ thromboembolism
• neurological damage (cord, nerve root avulsion)

2. Intermediate (days to weeks)
   - osteomyelitis
   - osteonecrosis
   - osteolysis
   - osteoporosis (disuse)
   - Myositis ossificans
   - joint mice (loose bodies)
   - synostosis
   - delayed union
   - reflex sympathetic dystrophy syndrome (RSDS)
3. Delayed (months to years)
   - DJD
   - non-union
   - malunion
   - aneurysmal bone cyst
   - pseudoarticulation
   - growth disturbances

Question 5

Non-accidental Injury to Childhood.

What are some radiographic indicators?

Answer 5

Look for radiographic indicators:

• multiple fractures in various stages of healing - atypical fractures
• metaphyseal corner fractures
• beware of mimics

Question 6

What are some normal structures/ variants that mimic fractures?

Answer 6

• nutrient canal
• ossicles and ununited growth centres
• MACH effect
• secondary growth centre

Question 7

Lunate dislocation

-tell me some info

Answer 7

• m.c carpal to dislocate
• hyperextension injury
• pie signs

Question 8

scapholunate di

Answer 8

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