B6-070 Multiple Trauma Fractures Flashcards
**content warning for child abuse**
what type of fracture tends to shorten and redisplace, even if splinted?
oblique/spiral complete fractures
in a […] fracture, the fragments usually remain in place after closed reduction
transverse
fracture with more than two fragments
comminuted
fracture where fragments are jammed tightly together and fx line is indistinct
impacted fx
fracture where bone is buckled or bent
seen in children because of increased plasticity of their bone
greenstick
fracture due to crumpled cancellous bone
seen in adult vertebral bodies
compression fracture
bone incompletely divided and periosteum remains intact
incomplete
mid portion of bone
diaphyseal
proximal and distal portions of bone [2]
metaphysis
epiphysis
diaphyseal fx can be [3]
simple
wedge
complex
proximal and distal fx can be [2]
extra-articular
intra-articular
displacement is described by relationship of
distal fragment to proximal fragment
displacement sideways, backwards, or forwards is called
translation
displacement causing tilt is called
angulation
if uncorrected, angulation will cause
malalignment
translation of fracture fragments in more than one plane is
rotation
bone breaks at a distance from where force is applied
indirect force
fractures occurring due to repetitive heavy loading
common in athletes, dancers, military
stress fractures
fractures treated operatively without callus formation
primary fracture healing
fractures treated non-operatively with formation of callus
secondary fracture healing
what type of bone demonstrates faster union?
cancellous
fractures unite faster in what age group?
children
factors that may prolong fracture healing
ischemia
infection
soft tissue interposition
misalignment
what type of fractures often go into delayed union or non-union?
open fx
leading cause of of childhood traumatic injury and death
non-accidental trauma
children between the ages of […] and […] are at the greatest risk of death from NAT
0-3
most common cause childrens death due to NAT
abusive head trauma
most common finding of child abuse in children:
second most common:
bruising/contusions
fractures
skeletal survey consists of at least […] radiographs spanning the skeleton
20
fractures that have high specificity for NAT [5]
classic metaphyseal lesions
rib fx (esp posterior medial)
scaupular fx
spinous process fx
sternal fx
infant held around chest, squeezed, and shaken may cause what fracture?
rib
caused by torsional and tractional shearing across metaphysis (pulling/twisting extremity)
classic metaphyseal lesions
scapular, spinous process, and sternal fractures results from
targeted blunt force trauma
fractures that indicates moderate suspicion for NAT
multiple fractures (especially bilateral)
fractures of different ages
most common type of shoulder dislocation
anterior
common glenoid fracture resulting from anterior dislocation
bankhart
common humerus fracture resulting from anterior dislocation
Hill-Sachs
Colles fracture typically results from
FOOSH
fracture of the distal radial metaphyseal region with dorsal angulation and impaction
Colles
ankle fractures are commonly due to what mechanism?
inversion
metaphyseal fractures in skeletally immature patients can involve the growth plate resulting in what class of fracture?
Salter-Harris
what 3 radiographic views should be ordered for an ankle fracture?
frontal
lateral
mortise
the modality of choice for further characterization/classification of ankle fractures, especially in pediatric patients
ankle CT
if diagnosed early, a scaphoid fracture will heal in […], if diagnosed late it can take up to […]
12 weeks
6 months
due to poor blood supply
The standard radiographic evaluation of a patient with a suspected shoulder injury should include what views?
frontal (internal/external rotation)
axillary
scapular Y views
types of fractures commonly associated with anterior shoulder dislocations [2]
Hill-Sachs
Bankart
serves as the foundation for evaluating patients in cases of suspected NAT
skeletal survey
The highly specific fractures for NAT include [5]
Rib fractures (particularly posterolateral)
classic metaphyseal lesions
scapular fractures
spinous process fractures
sternal fractures
the inferior component of an anterior shoulder dislocation is caused by
post-traumatic spasm in pectoralis
following a shoulder dislocation, why is it important to order post reduction radiographs?
to evaluate for Hill-Sachs fracture
fractured glenoid following shoulder dislocation
Bankart
gold standard for imaging traumatic shoulder pain
MR arthrography
why is it important to reduce a shoulder dislocation as quickly as possible?
to prevent muscle spasm
**can deepen Hill-Sachs
[…] ligament injuries represent approximately 85% of all ankle sprains
lateral
evident widening of the lateral clear deep space indicates
syndesmotic rupture (injury to intraosseous ligaments)
a triplane ankle fracture is most likely to occur in which age group?
12-14 years
Salter-Harris fracture refers to a fracture through the
physis (growth plate)
two-part triplane fractures can usually be treated with
closed reduction
three-part triplane fractures are typically treated with
surgical reduction
when initial radiographs are normal but there is a high suspicion for fracture […] can detect fractures of the distal radius and carpal bones
MRI without contrast
which portion of the scaphoid is most susceptible to AVN following fracture
proximal pole
children between the ages of […] and […] are at the greatest risk of death from NAT
0-3
the majority of deaths related to NAT are due to
head trauma
most common finding in NAT
cutaneous lesions
in skeletal survey, […] view of the ribs should be obtained to increase the accuracy of diagnosing fractures
oblique
initial imaging modality of choice for assessment of acute hip pain with suspected fracture
Xray
foramen made up by the ischium and pubic bones
obturator ring
an intact obturator ring helps to exclude a fracture of
pelvic rami
curvilinear line running from the iliosacral joint along the medial border of the iliac wing and superior border of the superior pubic bone
iliopectineal line
delineates the inner margin of the pelvic ring
iliopectineal line
most appropriate initial imaging study for patient with suspected diabetic osteomyelitis of the foot
conventional radiographic and MRI examinations are acceptable first-line imaging studies for evaluation of potential osteomyelitis
inexpensive and easy to obtain; poorly sensitive for osteomyelitis
xrays
expensive and difficult to obtain; highly sensitive and specific for osteomyelitis
MRI
Seen on Xray:
Irregularity of the cortical bone and periostitis
Gross destruction of the cortical and underlying trabecular bone
osteomyelitis (associated with diabetic nephropathy)
LOW T1 and HIGH T2 signal intensity
Marrow edema (osteomyelitis)
Marked INCREASED bony enhancement on post-contrast T1 weighted imaging
osteomyelitis
T1 and T2 weighted sequences are both sensitive at demonstrating
bony edema
study of choice for evaluation of a suspected, radiographically occult hip fracture
MRI
USPSTF recommends screening for osteoporosis in women starting at what age?
65
**or younger if fracture risk is equal to 65 year old
imaging examination that determines the density of the patient’s bones through attenuation of dual-energy x-ray beams
DEXA
Risk of avascular necrosis of femoral head increases with
degree of displacement of fracture
imaginary curved line drawn along the inferior border of the superior pubic ramus and along the inferomedial border of the neck of femur
Shenton’s line
Shentons line is a radiographic marker used to detect
superior femoral head subluxation (acetabular dysplasia)
