Upper Limb Fractures Flashcards
Define Fracture
Fracture is the (local) separation of an object or material into two, or more, pieces under the action of stress
List the 4 ways we classify fractures + what each means
- Open/Closed: communication with skin
- Complete/Incomplete: fragments 2 or more
- Simple/Comminuted: all cortex disrupted
- Direction
Apposition and alignment are defined in relation to ______ fragments
distal
List 5 terms used to describe apposition and alignment of fragments in a fracture
- displacement (medial lateral, posterior, anterior)
- angulation (medial, lateral, posterior, anterior)
- rotation (internal, external)
- overriding: overlap of fragments
- distracted: separated fragments
What type of fracture is shown

Complete fracture
What type of fracture is shown + define

Green Stick Fracture
Break of one cortical margin. Only with intact periosteum due to tension on soft growing bone
What type of fracture is shown + define

Torus Fracture
Buckling of cortex due to compression
Are smokers at an increased risk of fractures? Explain your answer
Smokers generally have lower bone density than non- smokers, so have a much higher risk of fractures.
Smoking also delays bone healing
Define a pathologic fracture + give 4 causes
Fracture at site of pre-existing osseous abnormality
Causes: tumor, osteoporosis, infection, metabolic disorder
(Image shows lucency at fracture site)

Compare a Stress vs Insufficiency fracture
(Fatigue) Stress Fracture are produced as a result of repetitive prolonged muscular action on bone that has not accommodated itself to such actions, activity related pain abating with rest
Insufficiency fractures occur when normal physiologic stress is applied to bone with abnormal elastic resistance/deficient mineralization
List 4 X-rays findings which may be seen with a stress fracture
- subtle blurring of trabecula margins
- sclerotic band (due to trabecular compression usually perpendicular cortex)
- gray cortex sign (subtle ill definition of cortex)
- Intra-cortical radiolucent striations (early)
What is seen on the X-ray below and therefore what type of fracture is this?

blurring of trabecula margins ➞ stress fracture
List 2 investigations to do if you suspect a stress fracture? (in additon to an X-ray)
- Bone Scan (gold standard)
- MRI
What may be seen on a bone scan in a patient with a stress fracture?
Stress fracture will appear as an area of increased uptake of tracer. Abnormal uptake is seen within 6-72 hours of injury ➞ prior to radiographic abnormality
If less intense (prefracture), ususally termed as stress reaction (focus of subtly increased uptake)
Abnormal uptake persists for months
Give 4 common sites for stress fractures to occur

Give 4 causes of an Insufficiency fracture
- osteoporosis
- paget/FD
- osteopetrosis
- osteomalacia/Rickets
- radiation
Give 3 X-ray findings indicative of an insufficency fracture
- Cortical lucency
- Periosteal reaction
- Sclerosis

List an MRI finding indicative of a Insufficiency Fracture
Marrow edema (low T1 High T2)
What type of fracture is this and why

Pelvic Insufficiency Fracture
- Fracture line
- Callus formation
- Honda sign: asymmetric incomplete H-shaped pattern of sacral uptake
Pathological Fractures are based on what 4 characteristics?
- tumor location
- associated pain
- type of lesion (either lucent, mixed, or blastic)
- lesion size
How are tumours scored?
1-3

If tumour is scored an 8+ what is advised surgically?
Fixation
What is Salter Harris?
Classification for Epiphyseal plate Injury
State the following regarding Epiphyseal plate Injurys
- peak age
- most common location
- upper vs lower limb prognosis
- shear force/compression
Peak age: 12 y
Radius most common (30%) others incl phalanges, distal tibia, humerus, ulna
Lower limb = worse prognosis
80% shearing force; 20% compression










































