How to describe a fracture

Question 1

What are the 7 descriptive things to describe descriptions of when describing a fracture

Answer 1

1. Mechanism & energy of injury
2. Skin & soft tissue
3. Site
4. Shape
5. Comminution
6. Deformity
7. Associated injuries

Question 2

What aspects of describing a fracture can be done purely from radiology?

Answer 2

Site

Shape

Comminution

Deformity

Question 3

What are the ‘rules of 2’ for trauma radiographs?

Answer 3

2 views - 90* from eachother, usually AP & lateral

2 joints - above & below

~2 bones - if appropriate - radius & ulna etc

~2 occasions - useful for scaphoid fractures etc - eg two weeks apart

Question 4

When describing site - what features should be discussed?

Answer 4

Side

Limb

Bone(s)

Region

Articular involvemenent

“Mrs Smith has a fracture in the femur of her right leg, located at the distal 1/3rd of the shaft - with no articular involvement”

Question 5

What are the different types of articular involvement?

Answer 5

Intra-articular +/- dislocation/subluxation

Ligamentous avulsion

Epiphyseal involvement

Question 6

What are the types of shapes of fracture?

Answer 6

Transverse

Oblique

Spiral

Complex

Question 7

What are transverse fractures?

What causes transverse fractures?

Answer 7

Complete fracture were the break is ~perpendicular to the long plane of the bone & the two broken ends are shifted apart

Usually result of a direct blow or trauma

Question 8

Describe oblique fractures & their causes?

Answer 8

Like a transverse fracture - but not perpendicular (a bit more angle-ey)

Caused by bending forces with a bit of rotation

Question 9

What causes spiral fractures?

Answer 9

Always due to a rotational force

Question 10

What causes complex fractures?

What other feature is often seen with complex fractures?

Answer 10

Combination of forces

Comminution is often seen

Question 11

What is meant by comminution?

Answer 11

Fragmentation of bone into small bits n pieces

Can be described as:

none

+, ++, +++

or by specific patterns - eg segmental, butterfly (shown below)

Question 12

Define ‘deformity’ in the context of describing a fracture

Answer 12

Movement of distal fragment with respect to supposedly stationary proximal fragment

Question 13

What are the 4 aspects of ‘deformity’?

What units are used for each

Answer 13

Displacement - angulation - rotation - angular deformity

Displacement:

• % of bone diameter
• ant, post, medial, lateral

Angulation:

• in degrees
• ant, post, varus, valgus

Rotation:

• in degrees
• internal & external

Angular deformity:

• in cm
• impaction, distraction, overlapping

Question 14

When describing soft tissue involvement - what should be looked for?

Answer 14

Air

• can be due to open fracture or gas forming organisms secondary (gas gangrene mmm)

Foreign bodies

• often seen in open fractures

Fluid levels

• haematomas