Radio - Fractures

Question 1

Views for a classic exam

Answer 1

Two views @90*
Include joint proximal and distal to fracture

Question 2

Places that are difficult to recognize fractures

Answer 2

Equine P3 - may not be displaced due to small space
May be visible days later after due to bone reabsorption

Question 3

Description characteristics

Answer 3

Open or close
Location
Type
Displacement

Question 4

Locations for fractures

Answer 4

Articular v non articular
Epiphysis, metaphysis, diaphysis

Question 5

Type of fracture

Answer 5

Complete/incomplete
Transverse/oblique/spiral
Simple/comminuted/multiple
Avulsion
Clip/slab
Pathologic
Salter Harris

Question 6

Displacement types

Answer 6

Distal fragment relative to proximal garment

Question 7

Open or closed fractures

Answer 7

Can always assume presence of infection or bacteria when fracture is open - sometimes gas or presence of anaerobic bacteria can be seen on radiographs

Question 8

Incomplete fractures

Answer 8

Only involves one cortex
Not very common in adults, visible in skeletally immature

Question 9

Fatigue or stress fractures

Answer 9

Develop due to abnormal stress loading into bone leads to inappropriate remodeling leading to micro fractures
Common in performance animals

Question 10

Complete fractures

Answer 10

Complete loss of bony continuity allowing overriding/deformation
More common than incomplete
Named by direction of fracture line

Question 11

Transverse fractures

Answer 11

Travels approx 90* to the long(horizontal) axis of the bone

Question 12

Oblique fractures

Answer 12

Long or short based on degree (90-45 = long, <45 = short)
Two corticles of each fragment are roughly in the same place without spiraling

Question 13

Spiral fracture

Answer 13

Oblique fracture but line curls or corks around bone
Tend to have extreme sharp points and edges

Question 14

Comminuted fracture

Answer 14

At least 3 fragments in a single bone
Lines are interconnected or converge

Question 15

Fissure fracture

Answer 15

One or more fine cracks that penetrate the cortex - longitudinal or spiral directions
Common secondary effects of comminuted fractures

Question 16

Segmental fractures

Answer 16

At least 3 or more fragments in a single bone
Lines are not connected
Free cortical segment may separate the two segments

Question 17

Compression fracture

Answer 17

Type of impaction fracture which cancellous bone collapses and compresses on itself, shorted or misshaped appearance
Very common in the spinal cord

Question 18

Avulsion fracture

Answer 18

Fractures at soft tissue attachment sites
Either breakage of bone or chip of bone

Question 19

Chip fracture

Answer 19

Fragment that usually chips off the corner of an articular margin - common in performance horses (acutely lame)

Question 20

slab fracture

Answer 20

If the fracture extends from one articular surface to the other - longitudinal

Question 21

Pathologic fractures

Answer 21

Fractures due to breakage under a normal, manageable amount of force = bone is not healthy
Underlying bony or systemic disease, fractures are secondary

Question 22

Condylar fractures

Answer 22

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

Question 23

Salter Harris fractures

Answer 23

Growth plate injury
Types 1-5 higher number = increased damage to physis

Question 24

SH type 1

Answer 24

Fractures are through physis
Best prognosis

Question 25

SH type 2

Answer 25

Most common
Fracture line is through the physis and metaphysis
Germinal layer is spared

Question 26

SH type 3

Answer 26

Not very common
Fracture line is through physis and epiphysis
Usually articular fractures

Question 27

SH type 4

Answer 27

Fracture line is through epiphysis, physis and metaphysis
Usually on articular fractures

Question 28

SH type 5 - Crushing/compression

Answer 28

Common cause of premature closure of physis = irregular limb deformities
Not easily visible on radiographs

Question 29

Radius and ulnar asynchronous growth

Answer 29

Ulna has one physis
Both bones have to grow at the same length/rate = subluxation of joints prox and distal

Question 30

Premature closure of distal ulnar physis

Answer 30

Radius keeps growth = carpal valgus deviation - pushes growthing limb laterally, radius bows dorsally
Sub lux of elbow is common

Question 31

Premature closure of distal radial physis

Answer 31

Not common
Shorted length of radius creates gap in humero-radio jt
Can cause subluxation in radiocarpal jt

Question 32

Direct bone healing

Answer 32

Good apposition
Osteoclasts can cross Haversian system (smaller gap)
Clean up bones to make room for vascularity

Question 33

Stages to secondary healing

Answer 33

Inflammatory phase
Repair phase
- organize hematoma
- mesenchymal cell migration
- vascular invasion
- callus formation
Remodeling phase

Question 34

ABCDS of radiograph evaluations

Answer 34

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

Question 35

Complications w fracture healings

Answer 35

Malunion
Delayed union
Non union

Question 36

Malunion

Answer 36

A healed fracture not returned to previous form, bone healing in an abnormal position
Involving joints = DJD

Question 37

Delayed union

Answer 37

Non healed fracture in the normal or expected amt of time
Take into account all factors for healing

Question 38

Nonunion

Answer 38

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

Question 39

nonunion

Answer 39

Loss of bone at ends of fractures
Note lack of callus, bones aren’t trying to regrow

Question 40

Hypertrophic nonunion

Answer 40

Can’t cross gap but leads to extensive callus
Can form psuedoarthrosis