Fractures Radiology

Question 1

What is a fracture?

Answer 1

A break in the structural continuity of bone or cartilage

Question 2

What are the four categories of fractures?

Answer 2

Open, Closed, Complete, Incomplete

Question 3

What is an open fracture?

Answer 3

Broken bone that penetrates skin

Question 4

What is a closed fracture?

Answer 4

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

Question 5

What is a complete fracture?

Answer 5

All cortices of bone have been disrupted

Question 6

How many fragments are typically seen in a complete fracture?

Answer 6

2

Question 7

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

Answer 7

Comminuted

Question 8

What is an incomplete fracture?

Answer 8

Only one portion of the cortex is disrupted

Question 9

Which type of fracture is relatively stable?

Answer 9

Incomplete fractures

Question 10

Where are incomplete fractures most common?

Answer 10

Short bones, irregular bones and flat bones

Question 11

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

Answer 11

Pain is too high to be in ideal position

Question 12

What are the elements of fracture description? (7)

Answer 12

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

Question 13

How are the shafts of long bones seprated?

Answer 13

Into 3rds

Question 14

What are the ends of the bones called?

Answer 14

Proximal or distal ends

Question 15

What are the ends further divided into?

Answer 15

Extra-articular and intra-articular portions

Question 16

How are fracture fragments described/named?

Answer 16

Describe the distal fragment in relations to the proximal segment

Question 17

What is displacement?

Answer 17

Loss of apposition or contact between broken surfaces of the fragments

Question 18

How is the direction of fracture line determined?

Answer 18

Described in reference to the longitudinal axis of a long bone

Question 19

What is a transverse fracture result of?

Answer 19

Bending force

Question 20

What is a longitudinal fracture a result of?

Answer 20

Force parallel to the shaft of the bone

Question 21

What is an oblique fracture a result of?

Answer 21

Diagonally oriented force

Question 22

What is spiral fracture a result of?

Answer 22

Torsional force

Question 23

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

Answer 23

Comminuted Fractures

Question 24

What is impaction?

Answer 24

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

Question 25

What is avulsion?

Answer 25

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

Question 26

What are stress fractures?

Answer 26

Incomplete fractures from repeated stress (hairline fracture of foot)

Question 27

What are other names for stress fractures?

Answer 27

Microfracture, fatigue fracture, insufficiency fracture

Question 28

What are the two ways that stress fractures can happen?

Answer 28

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

Question 29

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

Answer 29

6 weeks

Question 30

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

Answer 30

More abnormalities due to growing

Question 31

What is the Salter-Harris Classification?

Answer 31

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

Question 32

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

Answer 32

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

Question 33

What is closed reduction of a fracture?

Answer 33

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

Question 34

What is open reduction of a fracture?

Answer 34

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

Question 35

What is an ORIF?

Answer 35

Open Reduction, Internal Fixation

Question 36

How does cortical bone heal?

Answer 36

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

Question 37

How does cancellous bone heal?

Answer 37

Little to no callus formation. Healing via creeping substitution

Question 38

How does surgically compressed bone heal?

Answer 38

Direct osteoblastic activity with little to no callus formation

Question 39

What are the three phases of healing?

Answer 39

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

Question 40

How long typically do fractures take to heal?

Answer 40

4-8 weeks

Question 41

What is a Formation of Callus?

Answer 41

Radiodense periosteal and endosteal lines bridge the fracture gap

Question 42

What is primary bone union?

Answer 42

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

Question 43

What is early union?

Answer 43

A trabecular pattern appears across the fracture line

Question 44

What is clinical union?

Answer 44

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

Question 45

What is radiographic union?

Answer 45

Dense bridge of periosteal and endosteal callus unites the fracture site

Question 46

What is established union?

Answer 46

Cortical structure and remodeling begin to appear

Question 47

What is remodeling?

Answer 47

Trabeculae become reorganized along lines of weight-bearing stress

Question 48

What is fibrous union?

Answer 48

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

Question 49

What are the factors that influence healing? (12)

Answer 49

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