Fractures Flashcards
Cancellous bone
Spongy bone
The physical force required to break a bone always results in _____________.
Soft tissue injury
Fractures can be classified according to:
Site Extent Configuration Relationship of fragments to each other Relationship to environment.
Fractures classified according to site:
Epiphyseal Metaphysial Diaphesial Intra-articular Fracture-dislocation
Salter-Harris classification.
Used to describe fractures affecting epiphyseal or growth plate.
Type 1. Transverse
Type 2 (most common). Growth plate and metaphysis
Type 3. Growth plate and epiphysis
Type 4. Growth plate, metaphysis and epiphysis
Type 5. Compression fracture through growth plate.
Complete fracture
Bone is broken into two or more pieces.
Incomplete fracture
Bone is bent or cracked but periosteum remains intact.
Compression fracture
Bone is crushed.
Occurs in cancellous (spongy) bone.
Greenstick fracture
Bone is bent or partially broken. More common in children.
Perforation fracture
Result of missile wound
Stress fracture
Cracks in bone due to overuse or repetitive actions.
Common in tibia, metatarsals (March fracture), navicular, femur, pelvis.
Fractures classification according to configuration.
Linear (north-south) Transverse Oblique Spiral Comminuted (two or more fragments) Avulsion (ligaments pull bone apart) Compacted/impacted (bones/fragments driven into each other) Osteochondral (fragments of articular cartilage sheared from joint surface)
Comminuted fracture
Two or more fragments
Osteochondral fracture
Fragments of articular cartilage sheared from joint surface.
Colles Fracture
Transverse fracture of radius proximal to wrist.
Fragment rotates and displaces dorsally.
Often FOOSH
“Dinner fork”
Complications include malunion.
Reflex symptom dystrophy
Pain, swelling and vasomotor dysfunction of an extremity.
Can be a result of any trauma.
Smith’s fracture
Reverse Colles
Transverse fracture of the radius proximal to wrist.
Fragment displaced ventrally.
“Spoon”
Galeazzi fracture
Fracture of radial shaft and dislocation of distal radioulnar joint.
MOI: fall on hands with rotational component
Possible complications: ulnar nerve injury.
Bartons Fracture
Intraventricular-articular fracture of the distal radius with dislocation of the radiocarpal joint
Dorsal and palmar types.
Caused by fall on extended and pronates wrist.
Rolando Fracture
Comminuted intra-articular fracture through base of first MC bone
Three distinct fragments (T or Y).
Boxers/Brawlers fracture
Fracture of 5th MC
MOI: punching with closed fist
Pain and tenderness around knuckle; snapping/popping sensation, discolouration, misalignment of finger.
Monteggia Fracture
Fracture of proximal ulna with dislocation to head of radius.
MOI: FOOSH with hyperpronation; uncommonly blow to back of ulna.
Potts Fracture
Ankle fracture affecting one or both malleoli
Distal fibular fracture close to lateral malleolus
Deltois ligament can rupture and avulse medial malleoli.
Dupuytren’s fracture
Like Potts, but higher up fibula.
Medial malleolus avulses and talus pushed superior between tibia and fibula.
MOI: eversion with external rotation.
Jones Fracture
AKA dancer’s fracture
Injury to proximal end of 5th Metatarsal. (Midfoot).
Maisonneuve fracture
Spiral fracture of proximal third of fibula.
Associated with tear of distal tibfib joint and io membrane
Also medial malleolus fracture and possible of deltois ligament.
How are the Maisonneuve and Galliazi fractures similar?
Both associated with important ligamentous disruption
Toddlers fracture
AKA. Accidental childhood spiral tibial fracture.
Distal part of tibia. 9 months to 3 years old.
Trimalleolar fracture
Ankle fracture that involves lateral malleolus, medial malleolus, and distal portion of tibia.
Bennett’s fracture
Fracture-dislocation of 1st Carpometacarpal jt
MOI: longitudinal force along axis of 1st MC when thumb is flexed.
Swelling, pain, reluctance to use thumb
Stages of fracture healing.
- Cellular phase
- Vascular phase
- Primary callus phase
- Reparative phase.
- Remodelling phase
Cellular stage of fracture healing
First stage
Hematoma firms around fractured ends of bones.
Inflammatory response initiated
Mesh of fibrin forms around injury site
Granulation tissue eventually invades and replaces hematoma.
Vascular phase of fracture repair
Second stage
Specialized circulatory network forms around fracture
Proliferation of osteoblasts at periosteum
Formation of fibrocartilage bridge between fragment ends
Primary callus phase of fracture repair
Third stage
Soft callus formed from mass of osteoblasts and exudate
Osteoclasts clean up debris
Fibrous, immature bone (woven bone) gradually calcified
Movement decreases
Union around 4 weeks
Reparative phase of fracture repair
Fourth stage
Consolidation of immature bone into lamellar bone
Remodelling phase of fracture repair
Fifth and final stage
Remodelling of irregular surfaces, reshaping of marrow spaces, realignment along lines of stress
Osteonecrosis
Avascular necrosis of the bone
More common in bones that are poorly vascularized (scaphoid, neck of femur, talus, lunate).
