Week 2 - fractures and dislocations Flashcards
Define a fracture. (LO1)
“A fracture is described as a disruption in the continuity of all or part of the cortex of the bone.”
What are the different types of fractures relating to cause? (LO1)
- traumatic (acute)
- insufficiency
- stress
- avulsion
How do traumatic fractures occur? (LO1)
Generally the result of a sudden incident/impact that results in damage to the bone, e.g. sport or road traffic accidents.
How do insufficiency fractures occur? (LO1)
Result from a normal load on an “insufficient” bone, e.g. osteoporosis.
How do stress fractures occur? (LO1)
Due to a reasonable action repeated excessively resulting in abnormal stress on the bone, e.g. excessive marching in army personnel.
How do avulsion fractures occur? (LO1)
Result from a trauma to a ligament or tendon and usually occur in young athletic people.
What is the standard way to confirm a clinical diagnosis of a suspected fracture? (LO1)
X-ray
Some fractures may not be visible on an X-ray (particularly stress fractures), what are some indirect signs of a possible fracture? (LO1)
- The disappearance of normal fat stripes and fascial planes.
- Joint effusions.
- Periosteal reactions.
- New periosteal bone formation (faint white addition at the fracture site on x-ray).
What are the rules associated with taking an x-ray? (LO1)
- A minimum of 2 planes of view is necessary, 4 for scaphoid fracture.
- If multiple injuries are suspected or trauma has occurred, the field of view should be expanded in order to accommodate these.
Why do fractures become more visible with time before healing? (LO1)
Osteoclasts resorp the dead bone at the edge of the fracture site making the gap wider.
Which parts of the body would you not x-ray? (LO1)
- Ribs - make a clinical diagnosis, an x-ray won’t help you.
- Nose - mostly cartilage so won’t be able to see much.
- Coccyx - some point forwards, downwards, backwards, you might just be able to see the fracture.
N.B. if there is pain at the end of expiration (suspected pneumothorax), then x-ray of ribs is warranted.
What is meant by lucent lines on a fracture x-ray? (LO1)
A dark line indicating the fracture.
What do the different colours on an x-ray indicate? (LO1)
Black = air Dark grey = fat Light grey = water White = bone White stripe = epidermis
What is the rule regarding ring fractures? (LO1)
A rigid ring must break in at least 2 places so if you find one fracture, find another.
e.g. pelvis
What is the rule regarding paired bone fractures? (LO1)
If only one bone in paired bones is fractured, x-ray the joint above and below as there must be a dislocation/ligament disruption.
e. g. tibia/fibula
e. g. facial bones: maxilla, zygomatic, lacrimal, nasal (would take an additional x-ray of the neck in this case)
e. g. radius/ulna
What are the different categories to describe a fracture clinically? (LO1)
- Position.
- Path of fracture line.
- Simple or comminuted.
- Joint involvement.
- Closed or open (compound).
How would we further subcategorise the position of a fracture? (LO1)
- Angulation.
- Displacement.
- Distraction.
- Impaction.
- Rotation.
- Foreshortening.
How would we describe the angulation of a fracture? (LO1)
The degree of the angle, e.g. 45 degrees, followed by:
- Valgus - fracture ends of the bone pointing medially.
- Varus - fracture ends of the bone pointing laterally.
- Posterior - fracture ends of the bone pointing posteriorly.
- Anterior - fracture ends of the bone pointing anteriorly.
How would we describe the displacement of the bone as a result of the fracture? (LO1)
- Laterally displaced - away from the plane of the body.
- Medially displaced - towards the plane of the body.
Describe what is meant by distracted and impacted fractures. (LO1)
Distracted: two ends of the bone (from the fracture site), have been pulled away from each other.
Impacted: two ends of the bone have been crushed together at the fracture site.
Describe what is meant by rotation with regards to a fracture? (LO1)
- Medially rotated = the mobile fragment of bone is internally rotated.
- Laterally rotated = the mobile fragment of bone is externally rotated.
Describe what is meant by foreshortening of the bone in a fracture? (LO1)
This is when the bone fragments are completely misaligned, with one of the fragments moving so the ends of the two fragments overlap, visibly shortening the bone.
What are the four different paths of a fracture line? (LO1)
- Transverse (most stable) - horizontal line through the shaft.
- Oblique - diagonally through the shaft.
- Spiral - spiralling through the shaft.
- Longitudinal (least stable) - vertical along the axis of the bone.
If a fracture results in more than 2 fragments of bone, what is it referred to as? (LO1)
Comminuted fracture.