Describing fractures Flashcards
Buckle (Torus)
Fracture that results from mild compression/impaction forces along the long axis of the bone
Usually occurs at the metaphysis
Torus/Buckle: bending of a bone with a compressing fracture and outward bulging of the cortex; axial loading
Avulsion
Fracture in which a piece of bone is pulled off due to a tendon or ligament that is subjected to a force
Intra-articular fracture
Fracture that involves a joint
Often unstable and unlikely to heal without surgical intervention
Dislocation
Loss of joint surface/articular congruity
Left wrist x-rays show a transverse fracture line along the distal radiusmetaphyseal area with fragmentation and longitudinal intra-articular extension (radiocarpal joint)
Spiral
corkscrew-shaped fracture around the bone; twisting force
Comminuted:
fracture resulting in more than 2 pieces
Fissure:
an incomplete cortical break without bending
Greenstick:
bending of a bone on one side with a crack on the opposite side; angulated longitudinal force or direct perpendicular trauma
Intrinsic Bone Quality
Generalized osteopenia
Overall reduction in bone density
Imbalance in bone deposition and resorption, placing the bone at risk of pathologic fractures
Intrinsic Bone Quality
Periarticular osteopenia
Reduction in bone density surrounding joints
Classically a sign of rheumatoid arthritis
Intrinsic Bone Quality
Lytic lesion
Focal areas of bony hypodensity, which are classically a sign of multiple myeloma
intrinsic bone quality
Generalized osteosclerosis
Overallincrease in bone density
Intrinsic Bone Quality
Subchondral osteosclerosis
Increased bone density surrounding a joint, in the subchondral layer
Classically a sign of osteoarthritis
Left: normal bone density
Middle and right: osteopenia
less densisty at the joints, osteoarthritis
Displacement
Dorsal (posterior), volar (anterior) or lateral displacement of the distal fragment with respect to the proximal fragment
Distraction
Increased overall bone length; widening of the bone components
Injuries to the physis (growth plate)
S = Straight Across
Fracture travels straight across the physis
Cannot occur if the growth plate is already fused
~5-7% of growth plate injuries
Prognosis: excellent
Tx: non-operative management
Salter-Harris Type II
A = Above the physis
Fracture involves part of the growth plate, and then travels above the physis into the metaphysis
75% of growth plate injuries
Prognosis: excellent
Tx: non-operative management
Salter-Harris Type III
L = Lower or beLow the physis
Fracture involves part of the growth plate, and then travels below the physis into the epiphysis
~7-10% of growth plate injuries
Prognosis: potential to be unstable especially if the joint space is involved
Tx: may or may not be operative
Salter- Harris Type IV
T = Through the physis
Fracture travels through the metaphysis, through the physis, and through the epiphysis
~10% of growth plate injuries
Prognosis: usually unstable and can potentially lead to limb length discrepancies
Tx: operative management should be considered
Salter-Harris Type V
R = Ruined or cRushed physis
Fracture is a crush injury to the physis
< 1% of growth plate injuries
Prognosis: unstable and lead to limb length discrepancies
Tx: operative management should be considered
Sail sign
Elevation of theanterior fat padon lateral elbow radiograph to create a silhouette similar to the sail of a boat
Anterior fat pad is often normal
It indicates:
Presence of anelbow joint effusion
Presence of an intra-articular fracture
Radial head fracture in adults
Supracondylar fracture in children
Posterior fat pad on a lateral x-ray of the elbow is always abnormal
Where a fat pad is raised and no fracture is demonstrated, anoccult fractureshould be suspected
elbow, shoulder, hip, patella dislocations
Elbows
Most commonly dislocate posteriorly, particularly with fractures of the radial head, olecranon, or coronoid process
Shoulders
Dislocate anteriorly in 95% of cases
Hips
Dislocate posteriorly in 90% of cases
Patella
Tends to dislocate laterally
Note whether any dislocations are associated with a fracture, as this would be referred to as acomplex dislocation or fracture-dislocation
dislocation vs subluxation
Dislocation
Complete (100%) loss of articular congruity; no part of the articular surfaces of the bones contributing to the joint are touching each other
Subluxation
Partial (< 100%) loss of articular congruity; some part of the articular surfaces of the bones contributing to the joint are touching each other
subluxation on left
dislocation on right
Assessment of Soft Tissue
Air within the soft tissue
Look for air within the soft tissues, especially around the site of a fracture
Presence of air is indicative of a compound fracture
Assessment of Soft Tissue
Foreign body
Look for foreign bodies within the soft tissues - particularly shrapnel which may have been deposited during penetrating injury
Manipulative reduction & immobilization (splints)
Reduction
Fractured ends are manipulated back into position and immobilized using a splint or a cast
Should be achieved within a few hours after the injury
Reduction is either the definitive management or temporary until surgery can be performed
An x-ray must be obtained after immobilization to ensure adequate reduction
fracture complications
neurovascular, DVT, fat embolism, compartment syndrome
Fracture Complications
Osteomyelitis
Results from the spread of microorganisms from wounds associated with an open fracture
Most commonly caused byStaphylococcus aureus
fracture complications
Premature osteoarthritis:
Due to cartilage destruction and changes of the subchondral bone
Increased risk with:
Older age
Obesity
Repetitive joint use
Trauma
fracture complications
Complex regional pain syndrome:
Characterized by chronic pain, often of the distal limbs
Can occur after a fracture or surgery and is difficult to manage
Signs of Osteoarthritis
Key findings on x-ray (4)
Reduced joint space
Generally asymmetric
Subchondral sclerosis
Increased bone deposition surrounding the joint
Subchondral cysts
Cystic formations around the joint
Osteophytes
Bony projections along the joint line
(1)Joint space narrowing
(2)Osteophytes
(3)joint destruction
(4) Involvement of the carpometacarpal (CMC) jointwhich is very common
OA
Anteroposterior and lateral views showing
(1)Joint space narrowing
(2)Osteophyte formation
Signs of Rheumatoid Arthritis
Key findings on x-ray:
Reduced joint space
Generally symmetric
Articular surface erosions
Discontinuities in the bone plate
Periarticular osteopenia
Hypodensity of bone
surrounding the joint
Soft tissue swelling
Signs of Gout
Key findings on x-ray:
Well-defined erosions with overhanging edges
Normal bone mineralization
Relative sparing of the joint space
Tophi
Appear as soft tissue masses with higher density than surrounding soft tissue
Occasionally they are calcified
Gout
Indications for prompt Orthopedic consultation include:
Open fractures
Neurovascular injury with fracture
Extreme swelling/compartment syndrome
Unable to achieve or maintain reduction (including if ED is not experienced in fracture reduction, splinting or casting)
Forearm fractures with elbow or wrist dislocation
What type of fracture pattern?
communited
Describe the fracture.
Which bone?
Left humerus
Which part of the bone?
Middle/Midshaft or Diaphysis
Which type of fracture?
Spiral
Midshaft spiral fracture of the left humerus
Describe the fracture.
Which bone?
Right radius
Which part of the bone?
Distal or metaphysis
Which type of fracture?
Transverse
Distal transverse fracture of the right radius
