Traumatic fractures

Question 1

what is generally including when describing a fracture?

Answer 1

1. open vs closed
2. anatomic site and extent
3. type: complete vs incomplete
4. alignment of fragments
5. direction of fracture lines
6. special features
7. associated abnormalities
8. special types

Question 2

how do you describe anatomic site and extent for fractures? what is included?

Answer 2

long bones are divided into prox, middle, distal thirds

ends further divided into intra/extra-articular

Question 3

what is included in describing the type of fracture?

Answer 3

complete vs incomplete

complete = all cortices disrupted

incomplete = mostly in short bones and children. generally stable w/o subsequent stresses

comminuted fracture >2 fragments

Question 4

how do you describe the alignment of a fracture?

Answer 4

distal segment related to proximal

position: relationship to normal anatomic location

displaced vs non-displaced:

• direction, amount of displacement
• distraction, overriding, rotation

In alignment vs angulation (longitudinal relationship of fragment)

Question 5

List some special features for fractures

Answer 5

1. impaction → compression w/axial load
   
   • depression and compression
2. avulsion → tensile loading of fragment and main body of bone
   
   • muscle contraction or passive loading

Question 6

list the types of fractures more common in pediatrics

Answer 6

1. greenstick
2. torus
3. plastic bowing

Question 7

what is a greenstick fracture?

Answer 7

fracture on side of tensile loading

angular displacement common

Question 8

what is a torus fracture?

Answer 8

impaction fracture on side of compressive loading

Question 9

what is plastic bowing?

Answer 9

longitudinal compression forces exerted, capacity for elastic recoil exceeded

you get to the plastic region but not the deformation/failure point so no true break occurs just bending

Question 10

how many types of Pediatric physeal fractures are there? List them

Answer 10

9 (first 5 are main one)

1. Type I → growth plate only
2. Type II → physis and metaphysis
3. Type III → physis and epiphysis
4. Type IV → Epiphysis, physis, and metaphysis
5. Type V → crush injury of physis
6. Type VI → involves perichondral ring associated periosteum of physis
7. Types VII thr IX → do not directly involve physis, though may disrupt blood supply

Question 11

describe Types VII → IX fractures

Answer 11

1. VII → osteochondral fracture of epiphysis
2. VIII → fracture of metaphysis
3. IX → avulsion of periosteum

Question 12

how is healing in pediatric fractures unique?

Answer 12

1. remodeling phase more extensive
2. remodeling and potential for subsequent deformity higher
   
   • skeletal age
   • distance of fracture from growth plate
   • severity of displacement of fragment

Question 13

what are some concerns for healing from a pediatric fracture?

Answer 13

1. limb length
2. angulation
   
   • altered joint reaction forces
   • biomechanical stress

Question 14

tuning forks are good for screening for what types of fractures?

Answer 14

transverse fractures

less accurate for stress fractures