Musculoskeletal: FRACTURES

Question 1

Definition:

• A portion of bone becomes fragmented at the site of tendon insertion due to sudden and traumatic stretch of the tendon

Answer 1

• Avulsion Fracture

Question 2

Definition:

• A break in a bone where the skin over the site remains intact

Answer 2

• Closed Fracture

Question 3

Definition:

• A bone that breaks into fragments at the site of injury

Answer 3

• Comminuted fracture

Question 4

Definition:

• A break in a bone that protrudes through the skin

Answer 4

• Compound fracture

Question 5

Definition:

• A break on one side of the bone that does not damage the periosteum on the other side.
• Often seen in children

Answer 5

• Greenstick fracture

Question 6

Definition:

• A break in a bone that has failed to unite and heal after 9 to 12 months

Answer 6

• Nonunion fracture

Question 7

Definition:

• A break in a bone due to repreated forces to a particular portion in a bone

Answer 7

• Stress fracture

Question 8

Definition:

• A break in a bone shaped like an “S” due to torsion and twisting.

Answer 8

• Spiral Fracture

Question 9

Definition:

• Fracture through the entire epiphysis of a bone

Answer 9

• Salter-Harris type I
  
  • Good prognosis; very few complications to growth of the bone
  • Treatment:
    
    • Relocation as necessary, and cast immobilization

Question 10

Forces [3] that commonly cause Salter-Harris Type I fractures:

Answer 10

• Shearing, torsion or avulsion

Question 11

Definition:

• Fracture through the entire epiphysis and portion of metaphysis of a bone

Answer 11

• Salter-Harris Type II fracture
  
  • Prognosis:
    
    • Typically minimal, so limited negative impact on long term function
    • May cause decreased bone growth
  • Treatment:
    
    • Relocated and immobilized with a cast

Question 12

Common cause of Salter-Harris Type II fractures:

Answer 12

• Shear or avulsion with angular force.

Question 13

Definition:

• Fracture through a portion of the epiphysis

Answer 13

• Salter-Harris Fracture Type III
  
  • Prognosis:
    
    • May lead to long-term problems secondary to the fracture which crosses the physis and extends into the articular surface of the bone.
    • Still generally favorable prognosis, rarely resulting in significant deformity
    • Tillaux Fracture (Type III fracture of the distal tibia) has particularly poor prognosis
  • Treatment:
    
    • Relocation and immobilization
    • Occasionally requires ORIF

Question 14

Common causes of Salter-Harris Fracture Type III

Answer 14

• Typically occurs when the growth plate is partially fused
• Although rare, typically occurs in the distal tibia in adolescents

Question 15

Definition:

• Fracture through a portion of the epiphysis and portion of the metaphysis

Answer 15

• Salter-Harris Fracture Type IV
  
  • Prognosis:
    
    • If the fracture interferes with cartilage growth, may lead to premature local fusion of the bone causing joint deformity.
  • Treatment:
    
    • Surgical intervention (e.g. ORIF) generally necessary to restore alignment.
    • Prognosis related to quality of the alignment

Question 16

Definition:

• Compression injury of the epiphyseal plate
  
  • Nothing “broken off”

Answer 16

• Salter-Harris Fracture Type V
  
  • Prognosis:
    
    • Poor functional prognosis
    • Typically associated with growth disturbances of the physis
  • Treatment:
    
    • Typically found “after the fact” so no immediate interventions provided in this case
    • If acute: weight bearing protocols

Question 17

Common cause of Salter-Harris Fracture Type V

Answer 17

• Compression or crush injury of the epiphyseal plate, with no associated epiphyseal or metaphyseal fracture.

Question 18

Knee joint fractures:

• Most common structure involved in a knee fracture:

Answer 18

• Femoral condyle
  
  • Most common mechanism of injury is falling with knee subjected to shearing force

Question 19

Knee joint fractures:

• Common mechanism of injury for tibeal plateau fracture

Answer 19

• Combination of valgum and compression forces with knee in flexed position
  
  • Often occurs in conjunction with MCL injury

Question 20

Knee joint fractures:

• Common mechanism of injury for epihyseal plate fracture:

Answer 20

• Weight bearing torsional stress
  
  • Presents more frequnetly in adolescents where an ACL injury would present in an adult

Question 21

Knee joint fractures:

• Most common mechanism of injury for a patellar fracture

Answer 21

• Direct blow to patella due to a fall

Question 22

Unimalleolar Fracture

Answer 22

• Involves either the medial or lateral malleolus

Question 23

Bimalleolar fracture

Answer 23

• Involves both the medial and lateral malleolus

Question 24

Trimalleolar fracture

Answer 24

• Involves medial and lateral malleolus as well as posterior tubercle of the distal tibia

Question 25

Factors associated with of fractures in the elderly:

Answer 25

• low bone density
  
  • Other risk factors:
    
    • age
    • comorbid diseases
    • dementia
    • psychotropic medications

Question 26

Definition:

• Injury of the foot in which one or all of the metatarsal bones are displaced from the tarsus.

Answer 26

• Lisfranc Injury (Lisfranc Fracture)
  
  • Usually caused by crush injury or landing on foot from after fall from a significant height.
  • Often occurs when an athlete has foot planted and another athlete lands on his/her midfoot.