Final Flashcards
Open Fracture
A fracture that penetrates the skin
Comminuted fracture
Fracture in which two or more bony fractures have separated
Butterfly fragment
A comminuted fracture that has an isolated triangular shape
Non-Comminuted fracture
One that penetrates completely through the bone separating it into two parts
Avulsion fracture
Tearing of a portion of bone from muscular or ligamentous force
Impaction fracture
When a portion of bone is driven into an adjacent segment. DEPRESSED and COMPRESSION
Depressed (impaction) fracture
An inward bulging of the outer bone surface (tibial plateau and frontal bone).
Compression (impaction) fracture
Decreased size of the involved bone. Vertebral endplates are driven toward each other and compress intervening spongy bone
Greenstick Fracture
Primarily in infants and children under ten. Bone bends applying tension to the convex side and fracturing while concave side is intact.
Torus (buckling) fracture
Compression forces cause the cortex to bulge outward. Most occur in metaphysis and are a painful variation of greenstick
Infraction
This fracture is acutally a form of impaction fracture that is only moderately severe. Used to explain a minor localized break in cortex, leaving minimal bone deformity.
Chip corner fracture
A form of avulsion fracture that is a “chip” from the corner of a phalanx or other similar bone
Stress fracture
Caused by repetitive stress that creates microfractures until eventually the fracturing is faster than the rate of bone repair.
Occult fracture
(bone bruise)
Represents hemorrhage and bone marrow edema associated with trabecular microfracture
On T2 weighted images it appears as a high signal area and on T1 it appears as a speckled low intensity area.
Psuedo-fracture
Not an actual fracture
An insufficiency fracture or the result of vascular pulsations
Discrete areas of uncalcified osteoid
Fracture Orientation (oblique, spiral, transverse)
Oblique: Occurs along the shaft of the long tubular bone
Spiral: Torsion coupled with axial compression and angulation
Transverse: Occurs at a right angle to the shaft of the bone. uncommon in healthy bone but common in diseased bone.
Diastasis
Displacement or separation of a slightly moveable joint. MC pubic symphysis, skull, tib-fib syndesmosis
Chondral or osteochondral fracture
Fracture through a joint surface that may result from shearing, rotary or tangential impaction fractures. May consist of cartilage only or cartilage and bone. osteochondritis dissecans (convex surfaces of femoral condyles, talar dome and capitulum
Salter-Harris classification of epiphyseal injuries
Type 1: Growth Plate Type 2: GP and metaphysis Type 3: GP and epiphysis Type 4: All Type 5: compression
S-H type I
fracture through GP and usually radiograph is normal. DX is clinical because of tenderness and swelling over epiphyseal plate.
Complicated with scurvy, rickets, osteomyelitis, hormone imbalance.
can present as slipped capital femoral epiphysis
S-H type II
Injury is through the displaced GP and taking some of the metaphysis with it.
MC epiphyseal injury making 75% of cases. MC sites are radius (50%), tibia, fibula, femur, ulna
S-H type III
Fracture line is directed along the GP and then turns towards the epiphysis. It is an intra-articular fracture that may require open reduction treatment
S-H Type IV
Obliquely oriented vertical fracture that passes through the epiphysis, GP, and metaphysis.
MC distal humerus in those under 10 and distal tibia in those over 10.
S-H Type V
least common of all epiphyseal fracture.
Radiographs are normal until shortening of growth causes short bones or angular cessation.
Circulatory or inflammatory phase of healing
Cellular phase - Cellular inflammatory response creates a blastema of undifferentiated mesenchymal cells that replaces hematoma
Vascular phase - diverts blood and creates a swamp that induces osteoclastic activity
Primary callus phase - primary exudate that and tissue that develops around the edge of the fracture fragments
Reparative or metabolic phase
more orderly secretion of callus and replacing osteoid with a more mature version of bone
Remodeling or mechanical phase
Remodeling and realignment of bone and callus along the lines of stress. restoration of medullary cavity and bone marrow.
Pathologic fracture
Fx through a bone that is weakened by a local or systemic disease process. Usually transeverse and often appear quite smooth
Spatial relationships of fractures
Alignment - position of distal fragment compared to proximal fragment. Good is no angulation
Apposition - Closeness of the bony contact of the fracture site. Good - near complete, partial - partial bony contact, distraction - pulled apart
Rotation - inclusion of both segments is needed to determine if there has been rotation
Radiologic features of bone healing
within first 5 days resorption occurs widening the fracture line
within 10-30 days a veil of new bone formation occurs adjacent to the callus.
Callus is remodeled and the whole process takes 4-6 weeks in young patients and 6-12 in geriatric patients
Complications of fracture healing - immediate
Arterial injury - MC popliteal with femur tibia, knee disloc
Compartment syndrome - high pressure in compartment may cause necrosis of contained muscles dt lack of perfusion
Gas gangrene - appearnace of thin parallel linear streaks within muscle planes
Fat embolism syndrome - fracture of a major bone leaks fat for 1-5 days after
Thromboembolism - injuries that result in immobilization and bedrest may cause DVT. Hip, pelvis, LE
Complications of fracture healing - intermediate
Osteomyelitis Hardware failure Reflex sympathetic dystrophy syndrome Post-traumatic osteolysis Refracture Myositis Ossificans Synostosis Delayed union
Complications of fracture healing - Delayed
Osteonecrosis DJD Lead arthropathy and toxicity Osteoporosis Aneurysmal bone cyst Non-union Malunion
Delayed union
Slow bony union across a fracture may follow inappropriate immobilization, intrinsically poor vascularity, and age
Scaphoid, proximal femur and tibia
Non-union
Failure to complete oseous fusion across fracture
Distraction, infection poor immobilization and vasculature.
Midclavicle, ulna, tibia
Signs: Slow to appear rounding, lack of callus, sclerosis and pseudo arthrosis
Malunion
union in poor position can lose function, shorten limb
Aseptic necrosis
Necrosis from lack of blood to bone
Femoral, head, humeral head, scaphoid, talus
Disuse osteoporosis
Following healing there may be delay to full use due to pain, low function, nerve palsy,or failure to mobilize. Done density will then be affected and incomplete
Jefferson’s fracture
Bursting fracture of the ring of the atlas
Fracture through anterior and posterior arches
Posterior arch fracture of atlas
MC fx of atlas. Result of being compressed between occiput and posterior arch of axis during hyperextension. 80% have another Cx spine fx.
Transverse ligament rupture
Rare, odontoid usually breaks before ligament ruptures. Seen in jefferson’s, arthritis, 20% of down’s.
Abnormally wide ADI >3 mm adults and >5 mm kids. cord compression with 10 mm anterior displacement.
Steele’s rule of thirds
atlas ring into thirds
1/3 cord
1/3 space
1/3 odontoid
Hangman’s fracture
40% of axis fractures
Abrupt deceleration from high speed and fracture occurs during hyperextension.
Bilateral disruption of the pedicles of the axis. A teardrop fracture often occurs simultaneously
Teardrop fracture
Avulsion of the triangular-shaped fragment from the anteroinferior corner of the axis body
Odontoid type I, II, III
40-50% of axis fx
TI - Avulsion of the tip of odontoid process as a result of apical or alar lig stress
TII - Fx between odontoid and body. MC and MC results in non-union. may require surgery if >5 mm. unstable
TIII - Takes some of the body with it. heals better.
Wedge fracture
Compression of involved vertebrae bodies from forced hyperflexion. 2/3 occur at C5-7
Looks like a wedge
Burst fracture (Cx)
Vertical compression to the head causes NP to break through endplate and go into vertebral body. posterior fragments may cause neuro deficits.
Articular pillar fracture
MC at C4-7 and C6 esp
Altered shape of vertical height and may cause anterolisthesis.
On radiograph may appear as rotation or loss of segment height
Clay shoveler’s fracture
Avulsion to the SP. may appear as a double SP on image
Abrupt flexion of the head.
MC at C7 and surrounding. Stable Fx
LAmina and TP fractures
MC C5-6
Trauma with lateral flexion
Fx line tends to localize near its junction with pedicle
May produce VA injury
unilateral or bilateral facet dislocation
teardrop fracture may cause severe and unstable injuries dt forward dislocation of vertebra and rupture of posterior ligaments
Localized kyphosis and widening of interlaminar spaces and interspinous spaces
