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NYCC Bone & Joint > Intro to Trauma > Flashcards

Intro to Trauma Flashcards

1
Q

What is an open fracture?

A

Fx that breaks the skin
(AKA compound Fx)

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2
Q

What is the clinical significance of an open fracture?

A

concern for infection (osteomyelitis)

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3
Q

What is a closed fracture?

A

Fx does not break skin

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4
Q

What is a comminuted fracture?

A

1 bone in 3 or more pieces

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5
Q

What type of fracture is associated with a butterfly fragment?

A

comminuted

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6
Q

What is a segmental fracture?

A

single bone is broken in multiple places (comminuted), separating a segment of bone

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7
Q

What is an avulsion fracture?

A

tearing away of bone fragment by ligament/tendon/muscle

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8
Q

What is the term for the site where a tendon/ligament plugs into a bone?

A

enthesis

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9
Q

What is an impaction fracture?

A

portion of bone is driven into adjacent segment, appearing as white line instead of black radiographically

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10
Q

Name 2 location-specific diagnoses of impaction fractures

A
  • compression Fx (vertebral body, calcaneus)
  • depressed Fx (tibial plateau, frontal bone)
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11
Q

Name 2 types of stress fractures

A
  • fatigue Fx
  • insufficiency Fx
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12
Q

What causes a vertical/longitudinal fracture?

A

convex meets concave, causing concave to fail longitudinally

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13
Q

What is a pathologic fracture?

A

Fx through diseased, weakened bone

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14
Q

What is the most common orientation of pathologic fractures?

A

transverse

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15
Q

What is the term for spontaneous collapse of a vertebral body, creating the appearance of a flattened vertebral body?

A

vertebra plana
(patho Fx)

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16
Q

What is a fatigue fracture?

A

abnormal stress on normal bone, resulting in mechanical failure

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17
Q

What is an insufficiency fracture?

A

normal stress on abnormal bone, resulting in mechanical failure
(form of pathologic Fx)

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18
Q

What is the radiographic latent period in the extremities?

A

7-10 days

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19
Q

What is the radiographic latent period in the spine?

A

21 days

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20
Q

What are the possible radiographic findings of a stress fracture?

A
  • soft tissue swelling
  • solid periosteal lifting
  • white line (callus) perpendicular to wt-bearing trabecula
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21
Q

What are your next steps if you suspect a stress fracture in the 5th metatarsal, but radiographs look normal 5 days post-injury?

A
  • if not vital, rest & re-x-ray in 2wks
  • if vital, MRI or bone scan
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22
Q

What are the advantages of MRI?

A
  • more specific
  • allows soft tissue evaluation
  • no radiation
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23
Q

What is the “Honda sign?”

A

vertical ala + horizontal upper sacral insufficiency Fx
(eg. elderly pt w/ SI pain not getting better w/ adjustments)

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24
Q

What is a pseudofracture?

A

not a true Fx; zones of unmineralized osteoid which appears as radiolucent line transverse to long bone axis (dark line part of the way through bone)

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25
Q

What are other names for pseudofracture?

A
  • looser lines
  • milkman syndrome
  • umbau zonen
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26
Q

What is the list of differential diagnoses for pseudofracture?

A

Paget disease
Rickets
Osteomalacia
Fibrous dysplasia

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27
Q

What is an occult fracture?

A

radiographically invisible Fx

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28
Q

What are the most common sites of occult fractures?

A
  1. scaphoid
  2. tibia
  3. ribs
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29
Q

What is a stable fracture?

A

does not (or unlikely to) move during healing process

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30
Q

What is an unstable fracture?

A

possibility of progressive biomechanical failure (movement) or neurologic insult (spinal)

31
Q

What is mechanism of a transverse fracture?

A

shear (MC)
pathologic
tension

32
Q

What is orientation of a transverse fracture?

A

perpendicular to long axis of bone

33
Q

What is mechanism of an oblique fracture?

A

compression

34
Q

What is orientation of an oblique fracture?

A

30-60 degrees to long axis of bone

35
Q

What is mechanism of a spiral fracture?

A

rotation

36
Q

What is orientation of a spiral fracture?

A

60-89 degrees to long axis of bone (pointed end)

37
Q

What is a bone contusion?

A

hemorrhage, edema, microfracture of bone
(hurts like a Fx, treated w/ rest)

38
Q

How is a bone contusion visualized?

A

MRI (not visible on xray)

39
Q

What are kissing contusions?

A

bruising of 2 bones that run into each other

40
Q

What type of effusion is more important clinically?

A

intra-articular (joint) effusion

41
Q

What is a lipohemarthrosis?

A

liquid marrow leaking out of bone

42
Q

What is the FBI sign?

A

(Fat-blood interface)
dark transverse line representing marrow fat floating on top of blood that hemorrhages into joint capsule

43
Q

What 2 things are necessary to be able to see an FBI sign on x-ray?

A
  • intracapsular Fx
  • x-ray beam parallel to floor (not pointed at floor)
44
Q

What is another name for the anterior fat pad sign of the elbow?

A

Sail sign

45
Q

The “sail sign” is (sensitive/specific) for ____

A

sensitive for intracapsular Fx

46
Q

The posterior fat pad sign is (sensitive/specific) for ____

A

specific for intracapsular Fx

47
Q

What must be ruled out first if you find a transverse fracture?

A

patho Fx

48
Q

How are tubular bone fractures described?

A
  • alignment/angulation
  • apposition (degree of bone contact)
  • rotation (about long axis)
49
Q

What are the 4 types of joint injury?

A
  • subluxation
  • dislocation
  • diastasis
  • osteochondral Fx
50
Q

What is subluxation?

A
  • damaged lig. at least partially but less than dislocation
  • still have contact of articular (hyaline) surfaces
51
Q

What is dislocation?

A

complete loss of contact between articular (hyaline) surfaces of a joint

52
Q

What are your next steps for a dislocation?

A

immobilize & send to ER

53
Q

What type of joint does dislocation occur in?

A

synovial

54
Q

What type of joint does diastasis occur in?

A

fibrous (syndesmosis)

55
Q

What is diastasis?

A

displacement or frank separation of a slightly moveable joint (syndesmosis)

56
Q

What is an osteochondral fracture?

A

fracture through joint surface

57
Q

What is another name for osteochondral fracture?

A

osteochondritis dissecans (OCD)

58
Q

What are the most common locations of osteochondral fractures?

A
  • lateral aspect of medial femoral condyle (w/ ACL inj)
  • talar dome
  • capitulum
59
Q

Most osteochondral fractures require what type of imaging?

A

MRI arthrogram

60
Q

What is Bayonet apposition?

A

0% contact at Fx site, instead run together lengthwise

61
Q

How do you name a dislocation?

A

direction/plane + joint + “dislocation”

62
Q

Name 2 categories of pediatric specific injuries.

A
  • incomplete fractures
  • physeal injuries
    (NOT diagnoses)
63
Q

Name 2 types of incomplete fractures in children.

A
  • torus Fx
  • greenstick Fx
64
Q

What is the mechanism of a torus fracture?

A

compressive force (buckles cortex)

65
Q

What is the mechanism of a greenstick fracture?

A

angular force (breaks part way through)

66
Q

When would you suspect a salter harris fracture?

A

anytime a pediatric pt has physeal plate tenderness

67
Q

What are the 5 types of Salter Harris fractures?

A

1 = Slipped (through physis, often w/ slippage)
2 = Metaphysis + physis
3 = Epiphysis + physis
4 = Bi (both metaphysis + epiphysis + physis)
5 = crunch (crushing)

68
Q

What type of Salter Harris fracture is associated with a Thurston Holland fragment?

A

type 2

69
Q

What is the most common type of Salter Harris fracture?

A

type 2

70
Q

What type of Salter Harris fracture appears radiographically normal?

A

type 5

71
Q

What are 2 specific/named type 2 Salter Harris fractures?

A
  • SCFE (prox. femur)
  • Gymnast Fx (distal radius)
72
Q

Describe the typical patient with a slipped capital femoral epiphysis.

A
  • 10-15 yrs
  • obese
  • M > F
  • left > right
73
Q

How often are SCFE injuries found bilaterally?

A

20-30%, usually within 1 year of first Dx
(F>M)

NYCC Bone & Joint (20 decks)

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