Fractures, Dislocations, Trauma Flashcards
Borders/bones of the orbit
Roof: frontal bone, lesser wing of spenoid
Floor: maxilla, palatine, zygomatic bones
Medial wall: ethmoid, maxilla, lacrimal, sphenoid bones
Lateral wall: zygomatic bone, greater wing of spenoid
Apex: opening to optic canal
Base: opens to the face
Fractures of the orbit
Orbital rim fracture: fracture of bones forming outer rim
“Blowout” fracture: partial herniation of orbital contents through one of its walls (medial and lateral walls weakest)
Bones of the face
Zygomatic (2): cheekbones
Lacrimal (2): smallest. Medial wall of orbit
Nasal (2): slender bones located at bridge of nose
Inferior nasal conchae (2): located within nasal cavity
Palatine (2): rear of oral cavity and forms part of hard palate
Maxilla (2): upper jaw and hard palate
Vomer: forms posterior aspect of nasal septum
Mandible: articulates with cranium at TMJ
Fractures of the face
Nasal fracture: most common facial fracture
Maxillary fracture: classified by Le Fort
Mandibular fracture: often bilateral
Zygomatic arch fracture: associated with trauma to side of face
Le Fort I
Horizontal or “floating palate”
Fracture of maxillary alveolar ridge.
Spans the bony nasal septum. May involve pterygoid plates of sphenoid
Sx: swelling of upper lip, buccal surface bruising, malocclusion, loosening of teeth
Le Fort II
Pyramidal
Posterolateral maxillary sinuses, inferior orbital rim, lacrimal/ethmoid bones, nasofrontal suture
Sx: swelling/deformity to midface, widening of intercanthal space, mobility of upper jaw/nose, malocclusion, peri orbital oedema/ecchymosis, epistaxis, CSF rhinorrhea
Le Fort III
Horizontal: craniofacial dislocation
Superior orbital fissures, ethmoid and nasal bones, greater wings of sphenoid, frontozygomatic sutures
Sx: similar to type II, lengthening/flattening of face, orbital hooding, enophthalmis, ear drainage and haemotympanium.
Anatomy of C-spine
Cervical vertebrae: triangular foramen, bifid spinous process, transverse foramina (contain vertebral artery, vein, sympathetic nerves)
C1: atlas: no vertebral body, no spinous process. anterior arch contains facet for articulation with dens of axis, secured by transverse ligament of atlas
C2 (axis): odontoid process (dens), articulates with atlas.
Ligaments of spinal column
Ant and post longitudinal ligaments Ligamentum flavum Interspinous ligament Nuchal ligament (only C-spine) Transverse ligament of atlas (only C1)
Common spinal fractures
Compression Burst Jefferson Chance Hangmans
Burst fracture
Axial loading
Results in comminuted fracture of vertebral body
May be associated with retropulsion of bony fragments into spinal canal: unstable fracture with Neuro deficits
Chance fracture
“Seatbelt fracture”
Flexion distraction injury
Fracture through vertebral body, pedicles and spinous process
Can be associated with increased interspinous distance and facet joint separation
Unstable, neurological deficit.
Jefferson fracture
Axial loading injury
Fracture of anterior and posterior arch of C1
Imaging: Offset of lateral masses of C1
Usually not associated with neuro injury
Hangman’s fracture
Hyperextension compression injury
Fracture of pedicles of C2
Not usually associated with neuro deficit
Odontoid fractures
Type I: avulsion fracture of the tip
Type II: fracture of base of odontoid
Type III: through body of C2
Facet dislocation
Associated with disc herniation
Can be unilateral or bilateral
Unilateral: may affect nerve root
Bilateral: >50% of spinal cord injury
Humeral head fractures
Neer classification
Complications: axillary nerve avascular necrosis of humeral head
Scapular fractures
Rare. High energy.
Floating shoulder: scapula neck + clavicle fracture
Humeral shaft fracture
Bimodal: trauma + osteoporotic
Complications: radial nerve injury
Holstein-Lewis fracture: distal 1/3 of humerus + entrapment of radial nerve
Rx: ORIF with plate/conservative
Clavicle fracture
Allman classification: Type I: middle 1/3 (75%) Type II: lateral 1/3 (20%) Type III: medial 1/3 (5%): associated with mediastinal injury, pneumothorax, haemothorax Rx: most conservative. ORIF
Shoulder dislocation
Anterior: force applied when shoulder extended, abducted, externally rotated
Posterior: seizure/electrocution, anterior blow in flexion and adduction
Nerve: Axillary/suprascapular injuries
Bone: Bony Bankart, Hill-Sachs
Soft tissue: soft Bankart, rotator cuff injury, glenohumeral ligament avulsion
XR: “lightbulb” = posterior.
Supracondylar fracture
Common pads elbow injury: 5-7yrs
FOOSH in elbow extension
Gartland classification
Type I: undisplayed
Type II: displaced with intact posterior cortex
Type III: displaced in 2 or 3 parts
Type. IV: complete periosteal disruption
Complications: anterior interosseous nerve, ulnar nerve, malunion, cubitus varus deformity “gunstock”, Volkmann’s contracture
Rx: I & II: above elbow cast. II, III, IV: closed reduction and K-wire
Radial head fractures
FOOSH
XR: sail sign (elevation of anterior fat pad)
Mason classification:
Type I: <2mm displacement
Type II: partial articular fracture with >2mm displacement
Type III: comminuted fracture and displacement
Rx: I: non-operative. II: non-operative (if no block)/ORIF. III: ORIF/radial head excision.
Olecranon fractures
FOOSH. Inability to extend elbow
Classifications: Mayo or Schatzker
Rx: non-operative if <2mm displacement. Operative if >2mm displacement. olecranon plating/tension band wiring
Elbow dislocation
Usually occur in young adults Simple or complex Complications: ulnar nerve injury Rx: closed reduction Terrible triad: lateral collateral ligament injury, radial head fracture, coronoid fracture: results in very unstable elbow
Forearm Fractures
Galeazzi
Monteggia
Galeazzi fracture
Fracture of distal third of radius and dislocation of distal radioulnar joint
Complications: compartment syndrome, anterior interosseous nerve palsy
Monteggia fracture
Fracture of proximal third of ulnar and dislocation of proximal head of radius
Distal radius fractures
Colles’ (90%)
Smith’s
Barton’s
Colles’ fracture
Extra-articular fracture of distal radius.
Dorsal angulation and dorsal displacement
(Avulsion fracture of ulnar styloid)
Smith’s fracture
Extra-articular
Volar angulation of distal fragment
Barton’s fracture
Intra-articular fracture with associated dislocation of radio-carpal joint
Scaphoid fracture
