Common Fractures II Flashcards
Cervical Spine Fractures
General
Most common fractured levels
Cervical spineis susceptible to injury because it is highly mobile with relatively smallvertebral bodies
Most commonly fractured levels:
C2 (~30%)
C7 (~20%)
Result from:
Direct trauma
Axial loading
Secondary to exaggerated flexion or extension
Cervical Spine Trauma
Nexus criteria (5)
Nexus (National Emergency X-Radiography Utilization Study) Criteria
Set of validated criteria used to decide which trauma patients do not require cervical spine imaging
Sensitivity of 99.6% for ruling out cervical spine injury
May not be reliable with patient > 65 years of age
Criteria
Focal neurologic deficit present
Midline spinal tenderness present
Altered level of consciousness present
Intoxication present
Distracting injury present
If none of the above criteria are present, the C-spine can be cleared clinically by these criteria and imaging is not required
Jefferson Fracture
general
Fracture (burst fracture) of the first cervical vertebra (C1 or atlas)
33% are associated with a C2 fracture
Usually results from axial loading/compression injury
Diving headfirst into shallow water
Symptoms
Neck pain
Neurological deficit may be present
Most patients are neurologically intact
Open-mouth (odontoid) view is the most revealing
Hangman Fracture
general
Bilateral fracture in the pars interarticularis of the second cervical vertebra (C2 or axis)
Usually results from a hyperextension injury
Car accidents, diving injuries, or contact sports injuries
What determines stability?
The fracture is stable if the anterior longitudinal ligament and posterior longitudinal ligaments are intact
Symptoms
Neck pain
Neurological deficit may be present
Most patients are neurologically intact
Vertebral Compression Fractures
general
Most common type of osteoporoticfracture
Most common sites: T7–T8 and T12–L1
May results from significant force (MVC, fall from a height)
Associated spinal cord injury is often present
> 1 fracture
Signs & Symptoms
Osteoporotic fracture
Often asymptomatic
Non-osteoporotic fracture
Acute pain with bony tenderness at the fracture site
Muscle spasm
Vertebral Compression Fractures
Dx and Tx
Diagnosis
Based on physical examination and plain-film x-rays
Wedge-shapedvertebral body:compressionof the superior and/or anterior surface
CT scan should be obtained for significant trauma
MRI should be obtained if neurological symptoms or deficits are present
Treatment
Analgesics
Early mobilization and physical therapy
Kyphoplasty to relieve severe pain
Hip Fractures
general and complictions
Common fractures of older patients, particularly patients with osteoporosis as the result of minimal force
Trauma in younger
Fracture locations include:
Femoral head
Femoral neck – weakest part of the femur
Intertrochanteric
Subtrochanteric
Complications:
Osteonecrosis of the femoral head
Fracture nonunion
Osteoarthritis
Hip Fractures
S/Sx
Groin pain
Increased pain with passive hip rotation and resistance of hip flexion
Inability to ambulate
Shortening and external rotation of the affected leg
hip fx
dx and fx
Diagnosis
Based on physical examination and plain-film x-rays
AP pelvis and lateral view of the affected hip
A full femur view is obtained if a fracture is identified
CT or MRI is obtained for hips with negative plain-film x-rays, but high clinical suspicion
Treatment
Open reduction with internal fixation (ORIF)
Nondisplaced and impacted fractures in older patients
All femoral neck fractures in younger patients
Intertrochanteric fractures
Total hip replacement
Displaced femoral neck fractures in older patients
Ankle Fractures
general
Ligaments and stability
Common fractures that results from multiple mechanisms of injury
Inversion or eversion of the ankle
Direct blow
Includes:
Medial or posterior malleolus fractures of the tibia
Lateral malleolus fracture of the fibula
May be stable or unstable
Fractures that disrupt ≥ 2 of the ankle ligaments will be unstable
Disruption of the medial deltoid ligament may cause instability
maisoneuve fx
S/Sx
Pain and swelling at the injury site initially, then extension diffusely around the ankle
May be unable to bear weight
Tenderness at the proximal fibula
Proximal fibula fracture (spiral fracture) with anunstable ankle injury (widening of the ankle mortise on x-ray), often comprising ligamentous injury (deep deltoid ligament) and/or fracture of the medial malleolus → Maisonneuve fracture
ankle fx
Diagnosis & Treatment
Diagnosis:
Based on physical examination and plain-film x-rays
AP, lateral, and oblique views of the affected ankle
Treatment:
Depends on the stability of the ankle
Weber classification based on the lateral malleolus
Walking boot
Casting with no weight bearing
Orthopedic consultation
Open reduction with internal fixation (ORIF) – Maisonneuve fracture
Some Weber B fractures
All Weber C fractures
Fractures of the 5th Metatarsal Bone
Zones of the 5th metatarsal:
Zone I – Base/Tuberosity
Zone II – Metaphysis
Zone III - Diaphyseal
Fractures of the 5th Metatarsal Bone
general
MOI and S/Sx
Can be acute or stress fractures
Forced inversion of the foot and ankle
Signs & Symptoms:
Pain, swelling, and tenderness well-localized to the fracture site
Ecchymosis may be present
Pain is worse with weight bearing
Fractures of the 5th Metatarsal Bone
Dx
different zones
Based on physical examination and plain-film x-rays
AP, lateral, and oblique views of the affected foot
Zone I fracture – Pseudojones fracture (Dancer’s fracture)
Fracture through the base (tuberosity) of the 5th metatarsal due to plantar flexion and inversion
Common fracture and less serious than other 5th metatarsal fractures
Zone II fracture – Jones fracture
Fracture at the metaphyseal-diaphyseal junction that often occurs with ankle sprains
Higher risk for nonunion due to the zone being avascular
Zone III fracture – stress fracture
Left: Pseudojones fracture
Right: Jones fracture
Fractures of the 5th Metatarsal Bone
Tx of Zone I, II, III
Zone I fracture
Weight bearing as tolerated
Walking boot
Zone II or III fracture
Casting with no weight bearing
Orthopedic or podiatry consultation
Calcaneal Fractures
General
Fractures resulting from great force (axial load)
Falling from a height onto the heels
Often associated with other injuries
Thoracolumbar compression fracture
If not diagnosed and treated properly → long-term disability
~10% are missed at initial presentation in the ER
Calcaneal Fractures
S/Sx
Specific sign/test
Signs & Symptoms
Tenderness and swelling to the heel and hindfoot
Unable to bear weight
Mondor sign
A hematoma formed that extends distally along the sole of the foot
Pathognomonic finding for calcaneal fracture
calcaneous fx
Dx and Tx
Based on physical examination and imaging
Axial and lateral views of the affected foot
CT scan is done if:
X-ray is negative, but clinical findings suggest a calcaneal fracture
The Bohler angle is < 20˚=fx
More detail about the fracture is needed
Treatment
Casting with no weight bearing
Orthopedic consultation
Calcaneous fx
Bohler angle
Determined from the lateral view
Normal angle is 20-40˚
< 20˚ suggests a fracture of the calcaneus
Case 1
Describe the fracture(s) (include the involved bone(s), portion of the bone, and type of fracture)
Spiral fracture of the right 3rd metacarpal
