Fractures and skeletal injuries Flashcards
Complete fracture
These are fractures of the bone that have been entirely separated from each other so the cortex of the bone is no longer connected.
Radiological signs:
Discontinued cortical lining
The presence of an abnormal fat pad
Separation from the cortex circumferentially
Disruption to the cortex lining
Displacement of osseous fragments
Swollen soft tissue surrounding the fracture
A complete fracture could have a radiolucent line passing through the bone and it could be mildly, moderately, severely displaced, or even undisplaced.
A complete # can be caused by:
Trauma - Large impact with more force than the bone can handle
Osteopenia or osteoporosis will reduce the force needed to cause a complete # which increases the chance of a #
Stress # that isn’t treated properly which can lead to the complete fracture of a bone
oblique fracture
An oblique fracture is when the break is diagonal across the bone.
Describe: Oblique fractures are one of the most common kinds of broken bones. The fracture is a straight line that’s angled across the width of your bone. Oblique fractures can be referred to as complete fractures. This means the line of the break goes all the way through your bone.
Where?
Oblique fractures usually affect long bones, the most common ones include: Femur, Tibia, Fibula, Humerus, Radius and ulna, Clavicle.
Mechanism of Injury (MOI)
Oblique fractures are almost always caused by falls or other traumas like sports injuries. They’re usually caused by landing on your bone at an angle after a fall, or when your bone is hit suddenly from an angle (like in a car accident). If you’re at risk for falls, you might be more likely to experience an oblique fracture. People with osteoporosis (decreased bone density) have weakened bones and therefore, have an increased risk for all types of broken bones, including oblique fractures.
Associated radiological signs:
Skin swelling
A deformity or bump that is not normally on the body
Treatment
How long it takes you to heal depends on the severity of your fracture and which treatments you needed. Most people need a few months to recover from an oblique fracture.
Buckle fracture
Torus fractures, also known as buckle fractures, are incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex. They result from trabecular compression due to an axial loading force along the long axis of the bone.
These type of fractures are more common in children, especially aged 5-10 years, due to the elasticity of their bones. In adults, the commonest form of torus fracture by far is a buckle fracture of the ribs
There has been a single case report of a torus fracture of the distal radius in an adult.
Describe
They are usually seen in children, frequently involving the distal radial metaphysis
A buckle fracture is an incomplete fracture.
Incomplete fractures are a heterogeneous group of fractures that predominantly occur in the long bones of paediatric patients.
Radiological signs
buckling out of one or both of the cortex’s in a long bone
Greenstick fractures
Greenstick fractures are incomplete fractures of long bones and are usually seen in young children, more commonly less than 10 years of age. They are commonly mid-diaphyseal, affecting the forearm and lower leg. They are distinct from torus fractures.
Greenstick fractures occur when the force applied to a bone results in bending of the bone such that the structural integrity of the convex surface is overcome. The fact that the integrity of the cortex has been overcome results in fracture of the convex surface. However, the bending force applied does not break the bone completely and the concave surface of the bent bone remains intact.
Radiographic features
Plain radiograph
usually mid-diaphyseal
occur in tandem with angulation
incomplete fracture, with cortical breach of only one side of the bone
Depressed fractures
Depressed skull fractures result in the bone of the skull vault being folded (depressed) inward into the cerebral parenchyma. It is usually the result of a high energy impact to the skull.
Radiographic features
Rarely undertaken, especially outside of the paediatric population. The fracture is identified due to the projection of dense bone over the skull.
CT
The modality of choice in head trauma. The fracture is shown in detail along with any associated injuries.
Avulsion
Avulsion- An avulsion fracture happens when a piece of bone attached to a tendon or ligament gets pulled away from the main part of the bone.
Types of avulsion
- Pelvic avulsion fracture- This type of fracture happens in the hips, buttocks, or upper thighs. Sudden, forceful contractions of the abdominal, hip, thigh, or hamstring muscles can cause it. That can come from motions such as jumping, sprinting, or kicking.
- Fibular avulsion fracture- The fibula is the outer bone in your lower leg. A fibular avulsion fracture is usually caused by a sudden inward rolling of your foot.
- Medial epicondyle avulsion fracture- This is a type of elbow injury.
- Finger avulsion fracture
What? Where? How?
This usually results from an accident or traumatic injury. Avulsion fractures are common in the hip, elbow, and ankle in young people who play sports. However, you can have one anywhere in your body where soft tissue attaches to bone.
Avulsion fractures usually happen near a joint. At that point, your bones connect to each other with tough bands of tissue called ligaments and connect to muscles with other tissue bands called tendons. They’re more common in joints with a lot of overlapping connection points, such as your knees, or in parts of your body with many joints close together, such as your hands. In certain spots, like around your shoulder or hip, an avulsion fracture can happen when you dislocate the joint.
Mechanism of injury
The failure of bone most commonly results from an acute event with the application of usually sudden, tensile force to the bone through the soft tissue, or when chronic repetitive avulsive stresses lead to a piece of bone being pulled away by the soft tissue.
any avulsion fractures are apparent of plain radiographs. The avulsed bone fragment is typically displaced in the direction of the tendon, ligament or joint capsule which is attached to it 5. CT and/or MRI may be required for detection and further characterisation. Appearances will vary depending on classification 4:
acute: avulsed bone fragment with donor site and typically associated soft tissue swelling / joint effusion
subacute: fracture healing results in a mixed lytic/sclerotic appearance
chronic: sclerosis and osseous hypertrophy
simple fractures
-simple fractures are closed fractures which have not pierced the skin. Simple fractures are sub-divided depending on shape and placement of their fracture. Some of the classifications of fractures are more serous than others and require different interventions.
For example: transverse, oblique, spiral, comminuted.
-simple fractures can also be complete which span the entire bone or incomplete which do not span the bone.
-as simple fractures are a broad classification, treatment will either be immobilisation with a cast or surgical intervention
-simple fractures are commonly diagnosed using X-rays.
-simple fractures are most commonly caused by trauma. This occurs when the bone undergoes high stresses or high impact.
Comminuted
Type of broken bone where it is broken into more than two pieces.
Describe:
Fracture occurs when three or more separate bony components are created from the original bone.
Comminated fractures are similar to segmental fractures. However, they can be differed by the MOI, resulting in the bone breaking into several smaller, smaller bone fragments. All comminuted fractures are segmental however, not all segmental are comminuted.
Butterfly: large triangular fracture fragment created from two oblique fracture lines meeting. Commonly seen in long bones
Radiological signs:
Multiple bony fragments (three or more). Can be further described as butterfly and segmental
Butterfly fracture: elongated triangular detached from two other larger fragments of bone
The segmental fracture segment of the shaft isiolated by proximal and distal lines of fracture
Can have further radiological signs such as compound fractures, displacements, shortening, rotation and angulation.
Damage to surrounding tissue and organs, especially due to the level of force to do a comminuted fracture e.g. pneumothorax,
Happen due to trauma. Common causes include car accidents, fall from heights or an impact to the bone.
Compound
Compound, or open, fractures are categorised by a break in the bone with displacement resulting in the bone pushing through soft tissue into the outside environment.
Surgical significance due to the increased risk of infection, healing complications and soft tissue damage.
The Gustilo classification system is a way to classify and guide the healing process graded 1 through 3, with grade 3 having 3 further subclassifications.
Radiological appearances will show bone matter outside of the soft tissue border. Lower grades may show more soft tissue swelling than higher grades due to size of laceration and the higher-grade injuries bleeding outside of the body. Higher grades with larger lacerations may show lower density in soft tissue dependant on whether any soft tissue was lost. They may also show changes in the normal anatomical shape of the soft tissue.
Motor vehicle accidents account for 34.1% of compound fractures and crush injuries account for 39.5% of lower extremity compound fractures. The most common compound fracture is phalanx fractures accounting for 45% of all open injuries.
Incomplete
When only one side of the bone is broken and the other either remains intact or bends slightly but does not complete break into two pieces, it is called an incomplete fracture.
Mainly occur in long bones.
The majority of forearm and lower leg fractures occur after indirect injury (e.g. the fall on an outstretched arm or jump from a height) rather than a direct injury (e.g. strike with a bat). In these situations, the force applied and the angulation of the force results in a variety of injuries
Compound fracture
a bone fracture that is accompanied by breaks in the skin, causing the broken ends of bone to come into contact with the outside environment. A traumatic accident like a fall or car crash can break your leg or other bones in your body.
Any bone in your body can break, but compound fractures most commonly occur in your limbs (arms, hands, legs and feet).
he healthcare provider will do a physical examination and then order X-rays to see exactly how the bones are broken and how they need to be aligned. Sometimes healthcare providers require a more sensitive test, like an MRI (magnetic resonance images) or a CT scan (computed tomography) to fully assess the damage from the fracture.
Longitudinal fracture
Longitudinal fractures are fractures that occur along or nearly along the axis of the bone.
Commonly found in long bones.
How: high sudden impact/stress
Associated radiological findings: soft tissues swelling on observation
Mechanism of Injury (MOI): Longitudinal fractures typically occur due to direct trauma along a long bone such as fall of or crushing injuries on the mid-shaft of a bone. Torsional forces are another common mechanism of injury which happens to long distance runners tibial shaft, via inverting or everting the bone causing the fracture. Stress fractures also cause longitudinal fractures, which are repetitive stress of a bone causing cracks to the mid-shaft of a bone.
Compression fracture
a compression fracture occurs in the vertebra, from trauma or through weakening of the spine. (can cause the spine to collapse or shorten)
Describe the patient
the patient will appear hunched and lose height by about 15-20%. (kyphotic)
bony appearance
the break occurs in the thick and round parts of the vertebral front body. has a wedge-shaped appearance.
Radiological signs
What?
angular deformity and bone cortical will step off posteriorly and look coarse.
could be either a;
wedge shape appearance - one endplate is visible but not the posterior wall
pincer or split fracture - both endplates visible but not posterior wall
burst fracture - fractured both endplates and the posterior wall
Where?
the vertebrae
How?
due to traumas such as falls from height or could also be a result of osteoporosis from minimal movement such as coughing, reaching or sneezing
.
(including associated radiological findings e.g. soft tissue)
Mechanism of Injury (MOI)
osteoporosis or trauma
Impaction fracture
An impacted fracture occurs when the broken ends of the bone are jammed together by the force of the injury.
Describe: An impacted fracture is a complete fracture in which the fracture line is indistinct. It results from compression of cancellous bone in the long axis with the two bone fragments jammed tightly together. Impaction fractures happen when a bone is compressed. This puts pressure on the area, therefore causing parts of the bone to crumble under the weight of the compression.
Radiological signs: WHAT? If there is shortening of bone without loss of alignment, the fracture is impacted. The bone substance of each component is driven into the other. Usually also undisplaced.
WHERE? any bones
HOW? -Fragments are driven into each other
foreshortened
‘telescoped in’
Mechanism of injury: high levels of force through compression eg trauma.
Spiral fracture
Definition – A fracture that spirals around the bone.
Description – Spiral fractures are complete fractures of long bone that result from a rotational force applied to the bone.
Radiological signs
What – Spiral fractures are likely to be associated with displacement.
Where – Spiral fractures occur in long bones in the body, usually in the femur, tibia, or fibula in the legs. However, they can occur in the long bones of the arms.
How – Spiral fractures are usually the result of high energy trauma.
Mechanism of injury – Spiral fractures are caused by twisting injuries sustained during sports, during a physical attack, or in an accident.
