Radio - Fractures Flashcards
Views for a classic exam
Two views @90*
Include joint proximal and distal to fracture
Places that are difficult to recognize fractures
Equine P3 - may not be displaced due to small space
May be visible days later after due to bone reabsorption
Description characteristics
Open or close
Location
Type
Displacement
Locations for fractures
Articular v non articular
Epiphysis, metaphysis, diaphysis
Type of fracture
Complete/incomplete
Transverse/oblique/spiral
Simple/comminuted/multiple
Avulsion
Clip/slab
Pathologic
Salter Harris
Displacement types
Distal fragment relative to proximal garment
Open or closed fractures
Can always assume presence of infection or bacteria when fracture is open - sometimes gas or presence of anaerobic bacteria can be seen on radiographs
Incomplete fractures
Only involves one cortex
Not very common in adults, visible in skeletally immature
Fatigue or stress fractures
Develop due to abnormal stress loading into bone leads to inappropriate remodeling leading to micro fractures
Common in performance animals
Complete fractures
Complete loss of bony continuity allowing overriding/deformation
More common than incomplete
Named by direction of fracture line
Transverse fractures
Travels approx 90* to the long(horizontal) axis of the bone
Oblique fractures
Long or short based on degree (90-45 = long, <45 = short)
Two corticles of each fragment are roughly in the same place without spiraling
Spiral fracture
Oblique fracture but line curls or corks around bone
Tend to have extreme sharp points and edges
Comminuted fracture
At least 3 fragments in a single bone
Lines are interconnected or converge
Fissure fracture
One or more fine cracks that penetrate the cortex - longitudinal or spiral directions
Common secondary effects of comminuted fractures
Segmental fractures
At least 3 or more fragments in a single bone
Lines are not connected
Free cortical segment may separate the two segments
Compression fracture
Type of impaction fracture which cancellous bone collapses and compresses on itself, shorted or misshaped appearance
Very common in the spinal cord
Avulsion fracture
Fractures at soft tissue attachment sites
Either breakage of bone or chip of bone
Chip fracture
Fragment that usually chips off the corner of an articular margin - common in performance horses (acutely lame)
slab fracture
If the fracture extends from one articular surface to the other - longitudinal
Pathologic fractures
Fractures due to breakage under a normal, manageable amount of force = bone is not healthy
Underlying bony or systemic disease, fractures are secondary
Condylar fractures
Occur in mature animals - distal end of humerus, femur or proximal tibia
4 directions or types - influence type of repair
Lateral condylar fracture
Medial condylar fracture
Y fracture
T fracture
Salter Harris fractures
Growth plate injury
Types 1-5 higher number = increased damage to physis
SH type 1
Fractures are through physis
Best prognosis
SH type 2
Most common
Fracture line is through the physis and metaphysis
Germinal layer is spared
SH type 3
Not very common
Fracture line is through physis and epiphysis
Usually articular fractures
SH type 4
Fracture line is through epiphysis, physis and metaphysis
Usually on articular fractures
SH type 5 - Crushing/compression
Common cause of premature closure of physis = irregular limb deformities
Not easily visible on radiographs
Radius and ulnar asynchronous growth
Ulna has one physis
Both bones have to grow at the same length/rate = subluxation of joints prox and distal
Premature closure of distal ulnar physis
Radius keeps growth = carpal valgus deviation - pushes growthing limb laterally, radius bows dorsally
Sub lux of elbow is common
Premature closure of distal radial physis
Not common
Shorted length of radius creates gap in humero-radio jt
Can cause subluxation in radiocarpal jt
Direct bone healing
Good apposition
Osteoclasts can cross Haversian system (smaller gap)
Clean up bones to make room for vascularity
Stages to secondary healing
Inflammatory phase
Repair phase
- organize hematoma
- mesenchymal cell migration
- vascular invasion
- callus formation
Remodeling phase
ABCDS of radiograph evaluations
Alignment of fracture fragments
Bone - evident reabsorption at margins = callus
Cartilage- evaluation of adjacent joints
Device (implant) - change in position, bending/breaking, loosening
Soft tissue - swelling beyond 7-10 days
Complications w fracture healings
Malunion
Delayed union
Non union
Malunion
A healed fracture not returned to previous form, bone healing in an abnormal position
Involving joints = DJD
Delayed union
Non healed fracture in the normal or expected amt of time
Take into account all factors for healing
Nonunion
Not healing and no evidence of progression towards healing
Often muscle atrophy or lameness
Often occurs in distal radius and ulna of small breed dogs
nonunion
Loss of bone at ends of fractures
Note lack of callus, bones aren’t trying to regrow
Hypertrophic nonunion
Can’t cross gap but leads to extensive callus
Can form psuedoarthrosis
