Diagnosing & describing fractures Flashcards
Define a fracture
Breakage of a bone in a soft tissue envelope
Break in 1 cortex & exits the other
Name the types of fractures
- Oblique- diagonal break caused by twisting force or hit from angle e.g. falling onto side
- Spiral- caused by high energy twisting force- steeper angle than oblique fracture- need lateral view to help tell
- Transverse- horizontal break caused by bending force
- Comminuted- fracture w/ 3 or more pieces- high force/ major trauma
- Pathological fracture- fracture caused by underlying disease e.g. cancer, osteoporosis, paget’s
- Compression- Hairline fractures caused by compression e.g. in spine
- Avulsion- when a small chip of bone attached to tendon or ligament gets pulled away from pain part of the bone- muscle rupture
- Greenstick- in children- when bone has bent & incompletely fracture (doesn’t pass through both cortex, just one halfway)
- Complete (extends all the way through the bone) or incomplete (does not involve whole cortex)
- Open (compound- high risk of infection- non-union) or closed (simple)
- Intra-articular (involve joint line) vs extra- articular (fracture is above (away) joint line)
NOTE- Look at diagrams
Fracture classification systems?
AO classification
Salter-harris classification- epiphyseal plate fractures in children
Gardens classification- for hip
Weber classification- for ankle
How do you classify ankle fractures?
Weber classification
A- below syndesmosis (stable, so best type)
B- at syndesmosis (unstable)
C- above syndesmosis (very unstable)
Syndesmosis- fibrous joint that connects fibula & tibia
NOTE- check notes diagram!
How do you treat the different classifications of ankle fractures?
A= use cast
B & C= need operations
Note- important to reduce fracture quickly if pulses weak- antibiotics only needed if fracture is open & given before surgery
What are the 3 types of hip fractures?
- Intertrochanteric fracture- runs from greater trochanter to lesser trachanter
- Intracapsular femoral neck fracture- fracture on the neck fo femur- bad as reticular vessels are broke= lack of blood supply to head of femur
- Subtrochanteric fracture- below lesser trochanter
NOTE- view diagram on notes!
How do you classify intracapsular femoral neck fractures?
Gardens classification
- predicts development of avascular necrosis
Class I- incomplete fracture
Class II- complete, non-displaced fracture
Class III- complete, partially displaced fracture
Class IV- complete, fully displaced fracture
NOTE- view diagram on notes!
Describe blood supply to femoral head
Deep femoral artery- largest branch
Splits into medial circumflex femoral artery & lateral circumflex femoral artery
These arteries split again into reticular arteries- supply femoral head directly & are damaged in intracapsular fractures
Obturator artery- in ligament teres- small or non-existent in adults
How would you treat the different types of hip fractures & why?
Intracapsular fracture, displaced- independently mobile, does not use stick- total hip replacement if 40-50 y/o, otherwise dynamic hip screw
Intracapsular fracture, displaced- not independently mobile (unfit)- hemiarthroplasty
- replace femoral head because blood supply from reticular arteries is damaged & avascular necrosis will occur
Trochantic fracture- mobility is not a factor- dynamic hip screw
Subtrochanteric fracture- mobility is not a factor- intramedullary nail
NOTE- look at images of intramedullary nail & hip screw
How do you classify children’s fractures?
Salter- Harris classification
Type I- complete physical fracture w/ or w/out displacement
Type II- physical fracture that extends through metaphysics, producing a chip fracture of metaphysics which may be very small
Type III- physeal fracture that extends through epiphysis
Type IV- physic fracture plus epiphyseal & metaphysical fractures
Type V- Compression fracture of growth plate
NOTE- look at diagram on notes!!
Examples of upper limb fractures?
- Colle’s fracture
- Smith’s fracture
- Bennett’s fracture
- Monteggia’s fracture
- Galeazzi fracture
- Barton’s fracture
- Scaphoid fracture
- Radial head fracture
What is Colle’s fracture?
Fall onto extended outstretched hands
Described as a dinner fork type deformity
3 Features of the injury
- 1. Transverse fracture of the radius
- 2. 1 inch proximal to the radio-carpal joint
- 3. Dorsal displacement and angulation
What is Smith’s fracture?
Volar angulation of distal radius fragment (Garden spade deformity)
Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed
What is Bennett’s fracture?
Intra-articular fracture at the base of the thumb metacarpal
Impact on flexed metacarpal, caused by fist fights
X-ray: triangular fragment at the base of metacarpal
What is Monteggia’s fracture?
Dislocation of the proximal radioulnar joint in association with an ulna fracture
Fall on outstretched hand with forced pronation
Needs prompt diagnosis to avoid disability
