Fractures Radiology Flashcards by Josh P

What is a fracture?

A break in the structural continuity of bone or cartilage

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What are the four categories of fractures?

Open, Closed, Complete, Incomplete

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What is an open fracture?

Broken bone that penetrates skin

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What is a closed fracture?

A break where the skin and soft tissues overlying the fracture are intact

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What is a complete fracture?

All cortices of bone have been disrupted

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How many fragments are typically seen in a complete fracture?

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What is the fracture called if there are more than 2 fragments in a complete fracture?

Comminuted

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What is an incomplete fracture?

Only one portion of the cortex is disrupted

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Which type of fracture is relatively stable?

Incomplete fractures

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Where are incomplete fractures most common?

Short bones, irregular bones and flat bones

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Why can an ideal view not be seen in cases of trauma fractures?

Pain is too high to be in ideal position

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What are the elements of fracture description? (7)

Anatomic site and extent, type of fracture, alignment of fracture fragments, direction of fracture line, presence of special features, presence of associated abnormalities, special types of fractures that occur due to abnormal stresses or secondary pathological processes

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How are the shafts of long bones seprated?

Into 3rds

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What are the ends of the bones called?

Proximal or distal ends

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What are the ends further divided into?

Extra-articular and intra-articular portions

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How are fracture fragments described/named?

Describe the distal fragment in relations to the proximal segment

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What is displacement?

Loss of apposition or contact between broken surfaces of the fragments

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How is the direction of fracture line determined?

Described in reference to the longitudinal axis of a long bone

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What is a transverse fracture result of?

Bending force

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What is a longitudinal fracture a result of?

Force parallel to the shaft of the bone

What is an oblique fracture a result of?

Diagonally oriented force

What is spiral fracture a result of?

Torsional force

What type of fracture does not always have a clear direction?

Comminuted Fractures

What is impaction?

A result from compression forces related to axial loading. The bone drives into itself

What is avulsion?

A result of tensile loading of bone that causes bone fragments to be pulled away from the body of the bone

What are stress fractures?

Incomplete fractures from repeated stress (hairline fracture of foot)

What are other names for stress fractures?

Microfracture, fatigue fracture, insufficiency fracture

What are the two ways that stress fractures can happen?

Repetitive minor trauma to otherwise normal bone, Normal loading to an abnormal bone

How long does it take for stress fractures to show on radiograh?

6 weeks

Why are fractures in children more difficult to diagnose and detect?

More abnormalities due to growing

What is the Salter-Harris Classification?

A mnemonic used to reference a fracture in relation to the growth plate of a bone

What are the five categories in the Salter-Harris classification?

S-Straight Across A-Above L-Lower TE-Through Everything R-cRush

What is closed reduction of a fracture?

No surgical incisions are made. Use of manipulation, traction or combo of both

What is open reduction of a fracture?

External with a cast or splint, Internal with pins, rods, wires, plates screws. ORIF

What is an ORIF?

Open Reduction, Internal Fixation

How does cortical bone heal?

Formation of a new callus bridging the fracture gap (Wolfe's Law)

How does cancellous bone heal?

Little to no callus formation. Healing via creeping substitution

How does surgically compressed bone heal?

Direct osteoblastic activity with little to no callus formation

What are the three phases of healing?

Inflammation (10%), Reparative (40%), Remodeling (70%)

How long typically do fractures take to heal?

4-8 weeks

What is a Formation of Callus?

Radiodense periosteal and endosteal lines bridge the fracture gap

What is primary bone union?

Healing of a fracture occurs by trabecular new bone without callus formation

What is early union?

A trabecular pattern appears across the fracture line

What is clinical union?

Callus is seen uniting the fracture site, yet a radiolucent band remains between the fracture fragments

What is radiographic union?

Dense bridge of periosteal and endosteal callus unites the fracture site

What is established union?

Cortical structure and remodeling begin to appear

What is remodeling?

Trabeculae become reorganized along lines of weight-bearing stress

What is fibrous union?

Fracture site is clinically stable and painfree, with no evidence of the fracture line repair remaining

What are the factors that influence healing? (12)

Age, Degree of Trauma, Degree of Bone Loss, Type of bone involved, Degree of immobilization, infection, local malignancy, nonmalignant pathological conditions, radiation necrosis, avascular necrosis, hormones (HGH, corticosteroids), exercise and local stress