Fractures Flashcards
Complete fracture
Both sides of cortex are breached
Salter-Harris classification I
I - Fracture through the physis only (x-ray often normal)
Salter-Harris classification II
Fracture through the physis and metaphysis
Salter-Harris classification III
Fracture through the physis and epiphyisis to include the joint
Salter-Harris classification IV
Fracture involving the physis, metaphysis and epiphysis
Salter-Harris classification V
Crush injury involving the physis (x-ray may resemble type I, and appear normal)
Toddlers fracture
Oblique tibial fracture in infants
Plastic deformity
Stress on bone resulting in deformity without cortical disruption
Greenstick fracture
Unilateral cortical breach only
Buckle fracture
Incomplete cortical disruption resulting in periosteal haematoma only
What is the Salter-Harris classification system used for?
Physeal fractures
What is the Garden classification system used for?
Hip fractures of the femoral neck - blood supply disruption is most common in types III and IV
Garden type I
Stable fracture with impaction in valgus
Garden type II
Complete fracture but undisplaced
Garden type III
Displaced fracture, usually rotated and angulated, but still has boney contact
Garden type IV
Complete boney disruption
Ottawa rules for ankle x-rays
Ankle x-ray is required only if there is any pain in the malleolar zone and any one of:
- bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to 6 cm below the posterior border of the fibula)
- bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to 6 cm below the posterior border of the tibia)
- inability to walk four weight bearing steps immediately after the injury and in the emergency department
Undisplaced intracapsular fracture management
If no comorbidities - internal fixation (especially if young)
If major illness or advanced organ specific disease - hemiarthroplasty
Displaced intracapsular fracture management
<70 with no comorbidities - internal fixation (if possible), hip arthroplasty if not
>70 with no comorbidities - total hip arthroplasty
Major comorbidities or immobile - hemiarthroplasty
Extracapsular fracture management
Non special type - dynamic hip screw
Reverse oblique, transverse or sub trochanteric - intramedullary device
