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DIAGNOSTIC IMAGING II > Fractures 1 > Flashcards

Fractures 1 Flashcards

1
Q

What is a fracture?

A

A break in the continuity of a bone, often due to trauma or stress

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2
Q

What is a simple (Non-Comminuted) Fracture?

A

2 osseous fragments result from the fracture

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3
Q

What is a comminuted fracture?

A

More than 2 osseous fragments result from the fracture.
- More likely unstable
- Stabilization is provided with intramedullary rods, plates, and screws
- Non-union of one the fragments results in serious complications

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4
Q

What is a closed fracture?

A

A fracture in which the skin over the broken bone remains intact.

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5
Q

What is an open (compound) fracture?

A

A fracture where the bone breaks
through the skin, creating an open
wound.

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6
Q

What is a complete fracture?

A

A fracture that traverse the entirety of the osseous structure.
i.e. Transverse fracture

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7
Q

What is an incomplete fracture?

A

A fracture that partial traverses the osseous structure or results in bowing deformities.
i.e. Greenstick fracture

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8
Q

What is a displacement?

A

The movement of bone fragments from their original position after a fracture.

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9
Q

What is an angulation?

A

The angle formed between fractured bone fragments

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10
Q

What is shortening (impacted)?

A

When fractured bone fragments overlap, leading to a reduction in the overall length of the bone.
- Can see a zone of impaction (condensation) at the fracture site

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11
Q

What is an Intra-articular Fracture?

A

A fracture that extends into a joint, potentially disrupting the joint surface and function.

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11
Q

What is an Extra-Articular Fracture?

A

A fracture that occurs outside the joint surface.

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12
Q

What is an Intra-capsular fracture?

A

A fracture that occurs within the joint capsule, meaning they involve the portion of the bone that is inside the joint capsule and often affect the blood supply to the bone.

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13
Q

What are common locations for an Intracapsular fracture?

A

Hip and Shoulder

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14
Q

What is the significance of an Intra-capsular fracture?

A

Prone to complications such as avascular necrosis, delayed healing and increased likelihood of surgical intervention.

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15
Q

What is an Extra-capsular fracture?

A

Fracture occurring outside the joint capsule, meaning they involve the portion of the bone that is not within the joint capsule.

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16
Q

What is an Osteochondral fracture?

A

A fracture involving the cartilage
and underlying bone of a joint
surface.

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17
Q

What is a transverse fracture?

A

A fracture that runs straight across the bone, perpendicular to its long axis.

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18
Q

What is an oblique fracture?

A

A fracture that occurs at an angle across the bone.

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19
Q

What is a spiral fracture?

A

A fracture caused by a twisting force, creating a spiral pattern along the bone.

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20
Q

What is a Segmental fracture?

A

A fracture where a segment of the bone is isolated by two breaks, resulting in a “floating” bone fragment.

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21
Q

What is a butterfly fracture?

A

A comminuted fracture where a triangular fragment is isolated by two cracks that meet in the middle of the bone, resembling a butterfly.

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22
Q

What is a pathological fracture?

A

A fracture that occurs in a
bone weakened by disease (e.g., osteoporosis, tumors).

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23
Q

What is a stress fracture?

A

A small crack in the bone that results from repetitive stress or overuse.

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24
Q

What is an insufficiency fracture?

A

A stress fracture that occurs in weakened bone under normal stress, often associated with conditions like osteoporosis or rheumatoid arthritis.

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25
Q

What is a compression fracture?

A

A fracture that occurs when a bone is crushed, often seen in vertebrae.

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26
Q

What is an avulsion fracture?

A

A fracture where a fragment of bone is pulled off by a tendon or
ligament.

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27
Q

What is a Greenstick fracture?

A

An incomplete fracture where one
side of the bone bends and cracks, while the other side remains intact. Common in children due to their softer, more flexible bones.

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28
Q

What is a Torus (Buckle) fracture?

A

An incomplete fracture where the
bone compresses and buckles, typically occurring in the metaphysis of long bones. This
type of fracture is common in children and results from a compressive force.

29
Q

What is a Bowing fracture?

A

A type of fracture where the bone bends excessively without a distinct
break. It is similar to plastic deformation but involves a more significant curvature and is often seen in the forearm.

30
Q

What is a Salter-Harris Fracture?

A

A classification of fractures involving the growth plate (physis) in children, with five main types.

31
Q

Describe a Salter-Harris Type I fracture.

A

A fracture through the growth plate without affecting the bone.

32
Q

Describe a Salter-Harris Type II fracture.

A

A fracture through the growth plate and metaphysis, sparing the
epiphysis.

33
Q

Describe a Salter-Harris Type III fracture.

A

A fracture through the growth plate and epiphysis, sparing the metaphysis.

34
Q

Describe a Salter-Harris Type IV fracture.

A

A fracture that crosses the
metaphysis, growth plate, and epiphysis.

35
Q

Describe a Salter-Harris Type V fracture.

A

A crush injury to the growth plate, leading to potential growth disturbances.

36
Q

What is a Metaphyseal Corner Fracture (Bucket Handle Fracture)?

A

A fracture that occurs at the metaphysis, often seen in cases of non-accidental trauma (child
abuse). The fracture appears as
a corner or “bucket handle” on
X-rays.

37
Q

What are the three key stages of fracture healing?

A
  • Inflammatory phase
  • Reparative phase
  • Remodeling phase
38
Q

How long does the Inflammatory stage of healing last?

A

Days 1-7

39
Q

What cells are involved in the Inflammatory Phase of fracture healing?

A

Macrophages, neutrophils, platelets and fibroblasts

40
Q

Describe the process of fracture healing during the Inflammatory phase.

A
  • Blood vessels are damaged, leading to hematoma formation at the fracture site.
  • Inflammatory cells migrate to the site to clear debris and dead tissues.
  • Release of cytokines and growth factors, promoting the recruitment of other cells needed for healing.
41
Q

What are the early radiographic features of the Inflammatory Phase of fracture healing?

A
  • Visible fracture line with possible displacement or angulation.
  • Surrounding soft tissue swelling.
  • No visible bone healing or callus formation.
42
Q

How long does the Soft Callus formation of the Reparative Phase last?

A

1-3 weeks

43
Q

What cells are involved in the Soft Callus formation phase of the Reparative Phase?

A

Chondroblasts, osteoblasts, and fibroblasts

44
Q

Describe the process of the Soft Callus formation phase of the Reparative Phase.

A
  • Soft callus formation begins as fibroblasts lay down collagen and chondroblasts produce cartilage.
  • Angiogenesis occurs, with new blood vessels forming to supply the healing tissue.
45
Q

What are the radiographic features of the Soft Callus formation phase of the Reparative Phase?

A
  • Initial blurring of the fracture line as the soft callus begins to form.
  • Mild periosteal reaction may be visible.
  • No mineralization visible at this stage.
46
Q

How long does the Hard Callus formation phase of the Reparative Phase last?

A

4-16 weeks

47
Q

What cells are involved in the Hard Callus formation phase of the Reparative Phase?

A

Osteoblasts, osteoclasts, chondrocytes

48
Q

Describe the process of Hard Callus formation during the Reparative Phase.

A
  • Ossification occurs as the soft callus is replaced by woven bone (hard callus).
  • Osteoblasts lay down new bone, while osteoclasts remodel the area to remove excess bone and cartilage.
49
Q

What are the radiographic features seen at 4-8 weeks during the Hard Callus formation of the Reparative Phase?

A
  • Visible hard callus formation with increased radiodensity at the fracture site.
  • Fracture line may still be visible but becomes increasingly blurred.
50
Q

What are the radiographic features seen at 8-16 weeks during the Hard Callus formation of the Reparative Phase?

A
  • Continued hard callus formation with bridging of the fracture site.
  • Progressive obliteration of the fracture line.
51
Q

How long does the Remodeling Phase last?

A

Months to years

52
Q

What cells are involved in the Remodeling Phase?

A

Osteoclasts and Osteoblasts

53
Q

Describe the process of the Remodeling Phase.

A
  • The woven bone of the hard callus is gradually replaced by mature lamellar bone.
  • Bone is remodeled according to Wolff’s law, adapting to the mechanical stresses placed
    upon it.
  • Excess callus is resorbed, and the bone returns to its original shape and strength.
54
Q

What are the radiographic features of the Remodeling Phase?

A
  • Continued remodeling of the bone with a gradual return to normal cortical and medullary bone architecture.
  • Disappearance of the callus and reformation of the original bone contours.
  • The fracture line is no longer visible.
55
Q

What goes in the history when assessing for fractures?

A

Mechanism of injury, patient’s age, and underlying conditions

56
Q

What is included in the physical examination for fractures?

A

Inspection, palpation, and functional tests

57
Q

What are the imaging options for assessing fractures?

A
  • X-ray: First-line imaging modality
  • MRI: For soft tissue involvement and radiographically occult fractures
  • CT: For complex fractures and surgical planning
  • Ultrasound: Limited use, primarily for soft tissue evaluation
58
Q

What is the purpose of the Canadian C-Spine rule?

A

Helps to decide when cervical spine X-rays are necessary after trauma.

59
Q

What are some high-risk factors according to Canadian C-Spine rule?

A
  • Age 65 or older.
  • Dangerous mechanism of injury (e.g., fall from a height, high-speed motor vehicle collision).
  • Paresthesias in extremities.
60
Q

What are some low-risk factors according to Canadian C-Spine rule?

A
  • Simple rear-end motor vehicle
    collision.
  • Sitting position in the emergency
    department.
  • Ambulatory at any time.
  • Delayed onset of neck pain.
  • Absence of midline cervical spine
    tenderness.
61
Q

What is the purpose of NEXUS (National Emergency X-ray Utilization Study)

A

Determines when cervical spine X-rays are unnecessary following trauma.

62
Q

What is the NEXUS criteria?

A

Patients without any of the following can forgo cervical spine
X-rays:
* No midline cervical tenderness.
* No focal neurological deficit.
* Normal level of alertness.
* No evidence of intoxication.
* No distracting injury.

63
Q

What is the purpose of the Ottawa ankle rules?

A

Helps to decide when X-rays are necessary for ankle and foot
injuries.

64
Q

When are Ankle X-rays required according to the Ottawa ankle rules?

A

Required if there is pain in the malleolar zone and:
* Bone tenderness at the posterior edge or tip of the lateral malleolus.
* Bone tenderness at the posterior edge or tip of the medial malleolus.
* Inability to bear weight both immediately and in the emergency department.

65
Q

When are Foot X-rays required according to the Ottawa ankle rules?

A

Required if there is pain in the midfoot zone and:
* Bone tenderness at the base of the fifth metatarsal.
* Bone tenderness at the navicular bone.
* Inability to bear weight both immediately and in the emergency department.

66
Q

What is the purpose of the Ottawa Knee rule?

A

Helps to determine when X-rays are necessary for knee injuries.

67
Q

What are the criteria for the Ottawa knee rule?

A
  • Age 55 or older.
  • Isolated tenderness of the patella (no other bone tenderness).
  • Tenderness at the head of the fibula.
  • Inability to flex the knee to 90 degrees.
  • Inability to bear weight both immediately and in the emergency department for four steps.
68
Q

What is the purpose of the Ottawa Elbow rule?

A

Helps to determine when elbow X-rays are necessary.

69
Q
A

DIAGNOSTIC IMAGING II (9 decks)

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