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Recognizing Fractures(and describing them) Fracturas MD Mario I. Rojas Zegarra
Definitions
Fracture Dislocation Subluxation
Fracture
A disruption in all or part of the cortex of a bone All = complete Part = incomplete = childrenComplete fracture of the surgical neck of the humerus
Dislocation
The bony components of a joint no longer are in contact with each other There is complete disruption of the joint
R3
Dislocation of the metacarpalphalyngeal joint of the thumb
Subluxation
The bony components of a joint are partially in contact with each other There is partial disruption of the jointR3
Incomplete Fractures
Greenstick fracture through one cortex Torus buckling of the cortexAlso called Buckle fxGreenstick Fractures Buckle Fractures
How Fractures Are DescribedBy the direction of the fracture line By the relationship of the fragments By the number of fragments By communication with the atmosphere
How Fractures Are DescribedBy the direction of the fracture line
Transverse Diagonal or oblique Longitudinal Spiral
How Fractures Are Described
By the direction of the fracture line
Transverse perpendicular to the long axis of the bone Caused by a force perpendicular to shaft
How Fractures Are Described
By the direction of the fracture line
Diagonal or oblique caused by a force usually applied in the same direction as the long axis of the bone
How Fractures Are Described
By the direction of the fracture line
Longitudinal along the long axis of the bone
R3
How Fractures Are Described
By the direction of the fracture line
Spiral a twisting fracture caused by a torque injury such as planting the foot in a hole while running
How Fractures Are Described
By the relationship of one fracture fragment to another
Displacement Angulation Shortening Rotation
Most fractures display more than one of these abnormalities of position
How Fractures Are Described
By convention, abnormalities of position describe the relationship of the distal fracture fragment relative to the proximal fragment
Displacement
The amount of off-set of the distal fracture fragment relative to the proximal There is lateral displacement of the distal femoral fracture fragment in this caseLateral Medial
Angulation
The angle away from the normal that the distal fragment makes with the proximal In this case the distal fragment is angulated medially from the position it would have were it not fracturedMedial Lateral
Shortening
Overlapping of the ends of the fracture fragments Shortening is usually described by the number of centimeters of overlapMedial Lateral
There is also medial displacement here
Rotation
Almost always involves long bones (humerus and femur) Knee joint is in AP position (points forward) but ankle points lateral, in this case
Anteroposterior at knee
Lateral at ankle
How Fractures Are Described
By the number of fracture fragments1
1
2 3
Two fragments Simple More than two fragments Comminuted2
4
Simple
Comminuted
How Fractures Are Described
By the relationship of the fracture to the atmosphere
Closed Open or compound Best evaluated clinicallyOpen or compound fracture of the tibia communicates with outside air
Salter-Harris Fractures
Fractures that involve the epiphyseal plate alone or in combination with an adjacent part of the bone Why is the classification important?
Prognostic value
Type Is and IIs do well Type IVs and Vs can develop early fusion of epiphysis and shortening of that bone
Salter-Harris Classification
Type I Epiphyseal plate alone Type II Epiphyseal plate and metaphysis Type III Epiphyseal plate and epiphysis Type IV Epiphyseal plate, metaphysis and epiphysis Type V crush fracture of epiphyseal plate
Salter-Harris Classification
Type I Fracture through the epiphyseal plate alone Often difficult to detect without other side for comparisonR3
Salter-Harris Classification
Type II fracture of the metaphysis and the epiphyseal plate Most common type of Salter fracture Corner-sign small metaphyseal fragmentR3
Salter-Harris ClassificationType III Fracture of the epiphyseal plate and the epiphysis
R3
Salter-Harris Classification
Type IV Fracture through the metaphysis, epiphyseal plate and the epiphysis Poorer prognosis i.e. premature closure of epiphysisR3
Common Fracture Eponyms
Colles fracture Smiths fracture Jones fracture Boxers fracture
Common Fracture Eponyms
Colles fracture fracture of the distal radius with dorsal angulationR3
Common Fracture Eponyms
Smiths fracture fracture of the distal radius with palmar angulation Fall on a flexed handR3
Common Fracture Eponyms
Jones fracture fx base 5th metatarsal
Common Fracture Eponyms
Boxers fracture fx head 5th metacarpal with palmar angulation Most often the result of punching a person or wallR3
Easily Missed Fractures
Scaphoid fractures Buckle fractures of radius/ulna Radial head fracture Supracondylar fractures in children Posterior dislocation of the shoulder Hip fractures
Easily Missed Fractures
Scaphoid fractures common Pain in anatomical snuff box Fall on outstretched hand Can lead to avascular necrosis
R3
Easily Missed Fractures
Buckle fractures of radius/ulna Children Look for angulation of cortex Heal quicklyR3
Easily Missed Fractures
Radial head fracture Common May require multiple views to see it
Easily Missed Fractures
Supracondylar fractures in children
Supracondylar fractures can be difficult especially in children (this is an adult)
R3
Easily Missed Fractures
Posterior dislocation of the shoulder Humeral head looks like lightbulb Usually need another view like axillary or Y viewR3
Easily Missed Fractures
Hip fractures May be very subtle and require bone scan or MRI for diagnosis In this case, white zone of sclerosis is an impacted subcapital fractureR3
Easily Missed Fractures
Jones fracture fracture of the base of the 5th metatarsal Avulsion type fracture frequently caused by pull of peroneus brevis tendon
Fracture HealingIndistinctness of fracture line Bony callous production Bridging of fracture
Obliteration of fracture line
Remodeling of bone
Series of images shows indistinctness of fracture line with bony callous formation and, finally, obliteration of the fracture line. There are metallic rods transfixing the fracture.
R3
QuizCorrect answers on following slides in red
The two terms below that best describe the position of these femoral fracture fragments are: 1. Angulated 2. Comminuted 3. Displaced 4. Shortened 5. RotatedAnswer follows
The two terms below that best describe the position of these femoral fracture fragments are: 1. Angulated 2. Comminuted 3. Displaced 4. Shortened 5. RotatedThere is also a fracture of the patella
The terms below that best describe this fracture are: 1. Angulated 2. Comminuted 3. Rotated 4. Greenstick 5. SpiralAnswer follows
The terms below that best describe this fracture are: 1. Angulated 2. Comminuted 3. Rotated 4. Greenstick 5. Spiral
This is an example of a: 1. Comminuted fracture 2. Dislocation 3. Displaced fracture 4. Subluxation
Answer follows
This is an example of a: 1. Comminuted fracture 2. Dislocation 3. Displaced fracture 4. Subluxation
Posterior dislocation of the hip
This fracture most likely occurred: 1. An hour ago 2. A day ago 3. A week ago 4. A decade ago
Answer follows
This fracture most likely occurred: 1. An hour ago 2. A day ago 3. A week ago 4. A decade agoHealing stress-type fracture of the 3rd metatarsal already has significant callous formation indicating it is at least several days old
This is an example of a Salter-Harris: 1. Type I fracture 2. Type II fracture 3. Type III fracture 4. Type IV fracture
Answer follows
This is an example of a Salter-Harris: 1. Type I fracture 2. Type II fracture 3. Type III fracture 4. Type IV fracture
There is a fracture that extends through the epiphysis but not the metaphysis. There is also a fracture of the epiphyseal plate.
MUCHAS GRACIAS
I know my Fractures
POR SU ATENCION