Week 1- Orthopaedic Classifications and Imaging Flashcards
What are the 4 causes of fractures?
-Traumatic # = caused by abnormal trauma e.g. fall, sport, car accident
-Pathological # =fracture in bone weakened by disease
-Periprosthetic # = fracture at point of mechanical weakness of an
implant
-Avulsion # = tendon or ligament remains intact but pulls off bone fragment
What are the principles of classification?
understanding and appling standardised definition which are universal and allow consistency in classification and communication
What are the location identifiers?
- shaft (proximal, middle, distal) in long bones
- lateral, medial eg in ankle
- head, base eg in phalanx
- intraarticular, extraarticular eg in tibial plateau
- Epiphyseal (Proximal, Distal)
- Subcapital / Intertrocanteric / Subtrocanteric (e.g. In Hip)
- Supracondylar / Intercondylar (e.g. In Knee Or Elbow)
- Periprosthetic (Joint Replacements Or Previous ORIF)
What is the steps to classifying a diaphyseal fracture?
- What is the bone? Specific
- What 1/3 of the bone is fractured? Distal, middle of proximal 1/3
- Wgat type? Simple, wedge or multifragmentary
4a. If simple, what fracture pattern? Spiral, oblique or transverse
4b. If wedge, what fracture pattern? Intact or fragmentary
4c. If multifragmentary, what fracture pattern? Intact segmental or fragmented segmental
Name this fracture
Simple spiral fracture of the proximal femoral shaft
Radiopedia: There is a significantly displaced spiral fracture of the proximal femoral shaft with additional avulsion fracture of the lesser trochanter.
Name these simple fractures
Spiral
Oblique
Transverse
Name this fracture
Simple Oblique fracture of the middle 1/3 of the humerus
Name this fracture
Displaced simple transverse diaphyseal fracture of the right tibia middle 1/3
Name these two types of wedge fractures
Intact wedge
Fragmentary wedge
Name these two types of multifragmentary fractures
Intact segmental
Fragmental segmental
Name this fracture
Middle 1/3 humerus, fragmentary wedge fracture
Name this fracture
R ulna middle 1/3, intact wedge fracture
Name this fracture
tibial diaphysis, with an intermediate, intact segmental fragment,
What are the steps to end-segment fractures?
- What is the bone? Specific bone (bone page for no.)
- At which end is the fracture located? Proximal or distal
- type: Does the fracture enter the joint surface? No =extra articular (Go to 5), yes= articular (go to 4)
- a. type: if articular, is it partial (part of joint attached to metaphysis)? Yes (type B) , go to 6
- b. type: if articular, is it complete (no part of joint attached to metaphysis)? Yes (type c), go to 7
- Group: if extraarticular (A) what is the fracture pattern?Avulsion (1), simple (2), wedge or multifragmentary (3)
- Group: if partical articular (b) what is the fracture pattern? Simple (1), split and/or depression (2), fragmentary (3)
- Group:lf complete articular (c) what is the articular pattern? simple (1), multifragmentary (2)
- Subgroup: if complete articular (c) what is the metaphyseal fracture pattern? simple articular with simple metaphyseal (1)
simple articular fracture with multifragmentary
metaphyseal (2),
Multfragmentary articular with multifragmentary metaphyseal (3)
Label these
Extraarticular
Partial articular
Complete articular
What js an extra articular, type A fracture?
The fracture line may be metaphyseal or epiphyseal, but it always spares the articular surface although it may be intra capsular.
What is a partial articular, type b fracture?
The fracture involves part of the articular surface while the remainder of the joint remains intact and is solidly connected to the supporting metaphysis and diaphysis.
What is a complete articular, type c fracture
There is a disruption of the articular surface and the articular surface is completely separated from the diaphysis.
What are the additional classifications of fractures?
Relationship to the environment
- Open vs closed
Extent
- Complete vs incomplete
What are open fracture classifications (OTA-OFC)?
Name this pathological fracture
Myeloma: a malignant tumor of the bone marrow
Name this pathological fracture
Fibroma: typically a benign fibroid or fibroid tumor; composed of fibrous or connective tissue.
What is this special fracture?
FOOSH Scaphoid fracture
- Most common type of carpal bone fracture
- Pain at base of thumb-ASB tenderness
- Men 20-30 yrs, adolescents/young adults
- Needs specific scaphoid view
- 10% distal, 70%-80% Waist, 20% proximal pole
Name this special fracture
Colles Fracture = distal radius
- Transverse 1+ partially fragmentation of distal radius
- Distal component dorsally displaced and angulated
- Associated transverse fracture of Una styloid
- Also called a “dinner fork” or “bayonet” due to shape of forearm
- Often from FOOSH
- Common in osteoporotic bones, middle age → elderly
Name this special fracture?
Monteggia fracture
. dislocation of the radial head/proximal radio ulnar joint) with of the ulna
Name these special fracture?
Name this special fracture?
Weber A ankle fracture
- Fracture of the lateral malleolus distal to the syndesmosis
- Below level of ankle joint/mortise
- tib/fib syndesmosis intact
- Deltoid ligament intact
- Medial malicious often fractured
- Usually stable but can require ORIF
Name this special fracture
Weber B ankle fracture
• Fracture at the level of the syndesmosis
- At level of ankle joint, extending superiorly and laterally up fibula
- Tib/fib syndesmosis intact or only partially torn
- Deltoid ligament may be torn
- Medial malleolus often fractured
- Variable stability
What is this special fracture
Weber C ankle fracture
- Fracture proximal to the syndesmosis
- Above level of ankle joint
- Tib/fib syndesmosis disrupted
- Deltoid ligament injury or medial malleolus fracture present
- Unstable -requires ORIF
Name this special fracture
Lisfranc injury
- Crush injury, foot run over by car, land on foot from fall from height, sudden rotational force on plantar flexed forefoot
- Gap between base of 1st and 2nd proximal MT heads
- Disruption of ligament complex, fracture 4- DL
Name this special fracture
Jones fracture
- Can be mistaken for a sprain
- AP/oblique/lateral with foot fully dorsi flexed
- # diaphysis fifth metatarsal
Name this special fracture
Patella fracture
- Hard blow to front of knee
- Surgical vs conservative management
What are the 3 hip classifications?
- subcapital/ intracapsular fracture
- intertrochanter/ extracapsular fracture
- subtrochanteric fracture
What are the 4 intracapsular fractures
- Type I fractures have the best outcome. The bone ends are impacted into one another, which facilitates vascular re-growth.
- Type II fractures are not impacted and are thus less stable. However there is minimal displacement of the bones from the anatomically normal position, and this is beneficial.
- Type III fractures are complete but there is only partial displacement (50%).
- type IV fractures are complete with total displacement (50%). The two ends of bone are completely separated.
What are the OTTAWA ankle rules?
- An ankle x-ray series is required if there is pain in the Matteo lar zone and any
of the following: - Bony tenderness over posterior edge of lateral malleolus (distal 6cm)
or/and - Bony tenderness over posterior edge of medial malleolus /distal 6cm)
or/and - Inability to weight bear /immediately and in ED)
What are the OTTAWA ankle/foot rules?
- A foot x-ray series is required if there is pain in the mid foot zone and any of the following
- Bony tenderness over base of 5th metatarsal
or/and - Bony tenderness over the navicular
or/ and - Inability to weight bear /immediately and in ED)
What are the OTTAWA knee rules
A patient with knee pain qualifiers for an x-ray if:
- 55 years or older
- Unable to flex knee to 90°
- Inability to weight bear 14 steps
- Point tenderness at proximal fibular head
- Isolated point tenderness of patella
How do you describe a dislocation?
• Where has it occurred? • How has it typically moved? - anterior/posterior - medial/ lateral - superior/inferior
Why are fractures missed?
- Poor history and examination
- Not linking radiology with clinical findings
- Failure to examine all views
- Poor methodical approach
- Failure to order special views (1 view is 1 view too few)
- Failure to identity need for a comparison view
- Failure to get a second opinion
What are indications for for hip X-rays?
- trauma
- hip pain
- abnormal gait
- inability to weight bear
- arthropathy
- knee pain
What are types of hip X-Rays?
- AP
- Lateral
- Horizontal beam lateral
- Clements-Nakayama
- Dunn view
What does a pelvis X-Ray examine
Examines the main pelvis ring, obturator foramina, sacroiliac joints, symphysis pubis, acetabulum, sacral foramina and proximal femur.
What are indications for a pelvic X-Ray?
- Blunt trauma
- Generalized hip pain
- Arthropathy
- Post operative follow up after THR
- Paget’s disease
- Fall
