Fractures Radiology Flashcards
What is a fracture?
A break in the structural continuity of bone or cartilage
What are the four categories of fractures?
Open, Closed, Complete, Incomplete
What is an open fracture?
Broken bone that penetrates skin
What is a closed fracture?
A break where the skin and soft tissues overlying the fracture are intact
What is a complete fracture?
All cortices of bone have been disrupted
How many fragments are typically seen in a complete fracture?
2
What is the fracture called if there are more than 2 fragments in a complete fracture?
Comminuted
What is an incomplete fracture?
Only one portion of the cortex is disrupted
Which type of fracture is relatively stable?
Incomplete fractures
Where are incomplete fractures most common?
Short bones, irregular bones and flat bones
Why can an ideal view not be seen in cases of trauma fractures?
Pain is too high to be in ideal position
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
How are the shafts of long bones seprated?
Into 3rds
What are the ends of the bones called?
Proximal or distal ends
What are the ends further divided into?
Extra-articular and intra-articular portions
How are fracture fragments described/named?
Describe the distal fragment in relations to the proximal segment
What is displacement?
Loss of apposition or contact between broken surfaces of the fragments
How is the direction of fracture line determined?
Described in reference to the longitudinal axis of a long bone
What is a transverse fracture result of?
Bending force
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
