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Musculoskeletal > Language Of Fractures > Flashcards

Language Of Fractures Flashcards

1
Q

Both cortices of bone have been fractured

A

Complete Fx

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2
Q

Only 1 cortex has been fractured

A

Incomplete Fx

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3
Q

What is an open fx?

A

Fx site communicates with the outside environment

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4
Q

Skin and soft tissues overlying the fx are intact

A

Closed Fx

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5
Q

A fx that has more than 2 fragments?

A

Comminuted

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6
Q

What are the directions of fracture lines?

A

Transverse
Oblique
Spiral
NOTE: the steeper the angle the more unstable the fx

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7
Q

Fracture line is perpendicular to the cortical bone or long axis?

A

Transverse fx

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8
Q

Fracture line runs obliquely to the cortical bone or long axis?

A

oblique fx

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9
Q

Caused by torsional force that encircles the shaft of the long bone?

A

Spiral fx

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10
Q

What are some descriptive terms of fractures?

A 
Distraction
Impaction
Compression
Avulsion
Segmental
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11
Q

Opposing ends of fx fragments are kept apart?

A

Distraction

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12
Q

One fragment is forcibly driven or telescoped into an adjacent fragment, or kept pressed against each other?

A

Impaction

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13
Q

A form of impaction, where a flat surface of one bone forces the adjacent flat surface to compress (i.e. vertebral body)

A

Compression

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14
Q

Fragments of bone are pulled away from their original position by soft tissue attachments (usually tendon or ligament) causing displacement of the fx fragment?

A

Avulsion

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15
Q

What are some examples of avulsion fractures?

A

Mallet Finger
5th metatarsal fx
Sigone Fx (lateral plateau of knee)?

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16
Q

Fx of long bone at different levels creating at least 3 distinct segments?

A

Segmental

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17
Q

What is position?

A

Relationship of fragments to their normal anatomical structure

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18
Q

What is displacement?

A

Loss of position

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19
Q

Alignment

A

Relationship of the longitudinal axis of one fragment to another

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20
Q

What is angulation

A

Result of mal-alignment

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21
Q

NOTE

A

Use anatomical description to describe displacement and angulation (Volar, dorsal, medial, lateral)

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22
Q

NOTE

A

For position and alignment describe the distal fragment in relation to the proximal segment

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23
Q

What is a pathologic fracture?

A

Fracture that occurs through abnormal or weakened bone

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24
Q

What are the causes of pathologic fractures?

A
  1. Local bony changes secondary to infection, benign or malignant tumors, diffuse osteopenia, or systemic disease such as osteogenesis
  2. Stress fracture
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25
Q

What is a stress fracture?

A

Fracture resulting from repeated micro-trauma to otherwise normal bone (March fx, Tibia fx)

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26
Q

What are some clinical features of fractures? 5

A
  1. Pain & tenderness: Subjective, variable, may be only sx
  2. Loss of function: 2˚ to pain or loss of structural integrity
  3. Deformity: 2˚ to swelling, loss of tissue integrity, angulation, displacement of fx
  4. Abnormal mobility or crepitus
  5. Neurovascular injury: May exist without fx-Examine & document with any injury
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27
Q

What is the test of choice for dx of fx?

A

Radiographs

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28
Q

What is the minimum number of x-rays needed for fx dx?

A

Minimum of 2 views
90˚ apart (AP/Lateral)
Consider stress views/comparison views (pediatric elbow fx)

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29
Q

When would a CT scan be used for fx dx?

A

When x-ray is negative, but fx still suspected
CT allows cross-sectional imaging from a series of x-ray beams. The x-ray tube is rotated 360˚ around the pt, and the computer converts it into a 2 dimensional axial image

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30
Q

What 3 planes is the CT capable of imaging in?

A

Coronal, Sagital, Oblique

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31
Q

What is CT particularly useful in?

A

Very useful in evaluating fx and bone tumors

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32
Q

What is a Bone Scan?

What will the lesion look like?

A

Radioisotope technique indicative of blood flow and thereby of bone formation and destruction.
Lesion will show increased uptake of radioisotope and appear as a dark area in the bone.
NOTE: sensitive but not always specific. Helps if high probability dx prior to study

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33
Q

What are bone scans used to identify?

A

Lesions such as fx, infections, or tumor

Also used to assess for prosthetic loosening

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34
Q

What is an Arthrogram?

A

Technique of injecting contrast material into the joint to evaluate joint capsule and articular surface integrity. Radiologist uses fluoroscopy or ultrasound to guide needle placement into the joint.

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35
Q

When is an arthrogram useful?

A

Shoulders and hips to assess the labrum

Wrists to show any tear of small ligaments

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36
Q

What is an MRI?

A

Uses radio frequency in the presence of high magnetic field to produce high quality images of the body in any plane.

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37
Q

When is MRI useful?

A

Dx soft tissue injuries, tumors, stress fractures, and infection
Hip fx not showing on x-ray

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38
Q

What are the 4 terms related to fracture union?

A
  1. Delayed Union
  2. Nonunion
  3. Pseudoarthrosis
  4. Malunion
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39
Q

Fracture fails to unite in the expected time for healing. Fracture repair is occurring just slowly

A

Delayed Union

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40
Q

Failure of fracture fragments to unite with processes of bone repair having ceased

A

Non union

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41
Q

“False-joint”

A

Pseudoarthrosis

42
Q

When may pseudoarthrosis occur?

A

In a nonunion, when fragments are connected by dense fibrous tissue which allows motion

43
Q

What is a malunion?

A

Fracture has healed in less than optimal position (angulatory or rotary deformity)

44
Q

What are the stages of Fracture Healing? 5

A
  1. Periosteal/endosteal bleeding
  2. Hematoma formation
  3. Maturation of hematoma/ infiltration of osteoblasts and fibroblasts
  4. Formation of periosteal new bone and callous creation of vessels, progressive mineralization of new bone
  5. Remodeling
45
Q

What are the objectives of fracture mgmt?

A
  1. Restore function
  2. Achieve bony union
  3. Minimize or prevent deformity
46
Q

What are the closed treatment options?

A
  1. Reduction: Positioning the fx fragments back into anatomical position
  2. Immobilization: Holds the position of the fx whether it needed reduction or not
47
Q

What are some complications of immobilization? 3

A

Tissue atrophy
Arthrofibrosis (joint stiffness)
Dermal Irritation

48
Q

What are some examples of immobilization options?

A

Fiberglass/plaster casts
Braces
Splints

49
Q

What is a closed reduction? Describe process.

A

Procedure performed under local, regional, or general anesthetic.
Fx reduced then appropriate immobilization applied

50
Q

How are open fractures treated?

A

Open (operative) treatment

  1. Plates/screws/pins (stainless steel, titanium, cobalt chrome)
  2. Wire/cable (same material as above)
  3. External fixation (stainless steel)
  4. Intra-medulary nail/rod (stainless, titanium)
  5. Bioabsorbable screws/pins (poly-lactic acid derivatives)
51
Q

What are the indications for open (operative) treatment

A

Unstable fx not held by closed measures
When immobilization is impractical
Neurovascular compromise (depends on severity)

52
Q

What are 4 main fracture complications?

A
  1. Neurovascular injury/shock
  2. Compartment Syndrome
  3. Infection
  4. Malunion, Delayed Union, Non-union
53
Q

What can neuromuscular injury/shock cause?

A
  • Significant blood loss to induce shock, which can lead to death
  • Severe dysfunction of extremities and vital organ functions
  • Severe vessel injury may require vascular repair or amputation
54
Q

What is compartment syndrome?

A

Increased inter-compartmental pressure caused by tissue injury, bleeding, etc.
Compartment pressure> capillary pressure=ischemia

55
Q

If left untreated what does compartment syndrome result in?

A

Tissue ischemia and eventual tissue necrosis

Occurs within 4-8 hrs

56
Q

How does compartment syndrome present? 4

A
  1. Pain disproportionate to injury
  2. Pain with passive motion
  3. Tense muscle compartment
  4. May have numbness, tingling
57
Q

What Sx of compartment syndrome is a very late finding?

A

Pulselessness

Primary arterial injury should be 1st suspected and emergently treated if pulseless limb is identified

58
Q

How is compartment syndrome dx?

A

Clinical dx but if unsure, document compartment pressure measurements
Measured using a pressure needle (>30 mmHg or the difference b/t DBP and compartment pressure <30)

59
Q

How is compartment syndrome treated?

A

Urgent Fasciotomy

60
Q

When is an infection more likely and what other disease can develop from this?

A

2˚ to open fx

May have significant soft tissue infx or develop osteomyelitis

61
Q

How are a malunion, delayed union, and a nonunion corrected?

A

Often requires bone grafting procedure or bone stimulation to aid in healing or to correct deformity or dysfunction from malalignment

62
Q

How are Pediatric Epiphyseal Fractures Classified?

A

Salter/Harris Classification of Epiphyseal Fractures

There are 5 types (I, II, III, IV, V)

63
Q

Type I

A 
S=Straight
Complete separation from metaphysis
Non-displaced
Usually only immobilization is needed
Good prognosis
64
Q

Type II

A 
A=Above
Transverses physis, exits into metaphysis
Thurston-Holland Fragment
Most Common of all Physeal Fx
Patient usually 10 or older
Good Prognosis
65
Q

Type III

A

L=Lower
Intra-articular, transverses physis, exits into epiphysis
Less common than I, II
Anatomic reduction Critical
Growth arrest, healing usually not a problem

66
Q

Type IV

A

T-Through
Fracture line crosses physis, extends into both metaphysics, epiphysis
Usually requires surgery for anatomical reduction
May use bioabsorbable or metal fixation devices

67
Q

Type V

A 
R=Ram
Sever crush injury to physis 
May be dismissed as sprain
Growth arrest common, poor prognosis
Often difficult to differentiate b/t type I
68
Q

What is the most common of all physeal fractures?

A

Type II

69
Q

What is another name for a Type II epiphyseal fx?

A

Thurston-Holland Fragment

70
Q

This type of epiphyseal fx has complete separation from metaphysis?

A

Type I

71
Q

The fracture line crosses physis, extends into both metaphysis and epiphysis

A

Type IV

72
Q

This type of epiphyseal fx results from a severe crush injury to physis

A

Type V

73
Q

This type of epiphyseal fx may be dismissed as a sprain?

A

Type V

74
Q

Which type of epiphyseal fx has a poor prognosis and growth arrest is common?

A

Type V

75
Q

This type of epiphyseal fx is intra-articular, transverses physis, and exits into epiphysis?

A

Type III

76
Q

In which type of epiphysis fx is anatomic reduction critical?

A

Type III it’s critical

Type IV usually requires surgery for anatomical reduction

77
Q

In which type of epiphyseal fx may bioabsorbable metal fixation devices be used?

A

Type IV

78
Q

What 2 types of epiphyseal fx are often difficult to differentiate?

A

Type I and V

79
Q

Which types of epiphyseal fxs have a good prognosis?

A

Type I, II, III (growth arrest, healing usually not a problem)

80
Q

What are the general treatment principles of epiphyseal fractures?

A

Reduce Early
Reduce adequately
Strive for anatomic reduction

81
Q

What should be done if pt presents late with a Type I-III epiphyseal fx?

A

Consider leaving it alone
allow it to heal
Fx deformity with osteotomy later

82
Q

What should be done if pt presents late with a Type III-V

A

Late Open Reduction and Internal Fixation (ORIF) is better than allowing to develop a deformed joint

83
Q

T/F Most epiphyseal fxs result in growth disturbance

A

False only 5-10% result in any growth disturbance

84
Q

What x-rays are helpful in the dx of epiphyseal fxs?

A

Stress films and/or comparison view are often helpful

85
Q

When should follow up radiographs be done in epiphyseal fxs?

A

6 mo and possible 1 yr

Comparison films may again be helpful

86
Q

What are some other common pediatric fractures?

A

Torus or Buckle Fx
Supracondylar Elbow Fx
Greenstick Fx

87
Q

Which fat pad is always pathologic? Anterior or Posterior?

A

Posterior

88
Q

What are some characteristics of a non-accidental skeletal trauma in a child?

A
  1. Must have Clinical Suspicion
  2. Unusual Behavior
  3. Inconsistent Hx
  4. Multiple fractures and different stages of healing
  5. Specific Fracture Patterns
  6. Family Stress Fratures
    85% of fx under age 3 are non-accidental
89
Q

What is a Galeazzi fx?

A

Displaced fx of the distal radius with dislocation or fx of the distal ulna
OR
Fx of the distal ulnar physis

90
Q

What is a Monteggia Fx?

A

Fx of the proximal ulna and dislocation of the radial head

91
Q

What is a Segond Fx?

A

Avulsion fx of the knee, lateral tibial plateau

92
Q

What are 75% of Segond fxs associated with

A

ACL ruptures

93
Q

What is a Jones Fx?

A

Base of 5th metatarsal (MT) in zone 2

94
Q

What is a Boxer’s Fx?

A

5 metacarpal (MC) neck fx

95
Q

What is a torus fx?

A

Least complicated

has buckling of cortex on one side only

96
Q

What is a Greenstick fx?

A

Has disrupted cortex on one side, with intact or buckled cortex on the other side

97
Q

Which type of fx discussed so far is the most complicated?

A

Galeazzi fx

98
Q

Where is the most common location for fxs in children?

A

Distal 1/3 of forearm

99
Q

What is a Colles Fx?

A

Distal end of radius fx and angulated dorsally aka Fork Fx (the wrist tilts upward)
Extension fx of radius
Usually from fall on outstretched wrist

100
Q

What is a Smith Fx?

A

Reverse Colles Fx distal end of radius fx angulated toward volar surface
Flexion fx of radius

101
Q

What site is the most common site for fx in adults?

A

Fracture of the distal radius

Musculoskeletal (2 decks)

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