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FRACTURES

(On Which We Will Likely Be Pimped)

Lindsay Gould

July 2006

JEFFERSON FRACTURE
Fracture of C1 ring Axial loading injury with compression force to C1 Unilateral or bilateral fractures of anterior and posterior arches of C1

CLAY-SHOVELERS FX
Avulsion fracture of spinous process of C7 or T1 Sudden load on flexed spine

HANGMANS FRACTURE
Bilateral pedicle or pars fractures involving C2 vertebral body A/w anterior subluxation or dislocation of C2 vertebral body Severe extension injury (MVC causing head to hit dashboard, hanging)

CLAVICULAR FRACTURE
Extremely common Does not completely ossify until late teens Fall on outstretched hand, fall onto outside of shoulder, direct hit to clavicle Treatment: Figure-of-8 sling; No activities that exacerbate pain; full recovery in 12 weeks.

SCAPULAR FRACTURE
Uncommon Scapular body fx are the MC type Commonly (80-90%) associated with other injuries lung and chest Dont require surgery GLENOID (cartilage) fracture requires surgery when unstable or fragments are far out of alignment

HUMERUS FRACTURE
Proximal occur near the shoulder joint; treatment depends on rotator cuff tendon position Mid-shaft Injury to radial nerve causes wrist drop and numbness of the hand dorsum Distal are uncommon in adults; often require surgery Most heal without surgery Over 90% with nerve injury have complete recovery of nerve in 3-4 months

HOLSTEIN-LEWIS FRACTURE
Distal third humeral fracture 18% are associated with radial nerve palsy, particularly if break is between middle and distal thirds of humerus Due to direct blow or torsion injury Competitors in throwing events

ULNAR FRACTURE
Forearm is struck by an object Nightstick Fracture

Treatment of isolated ulnar fx: cast or brace; surgery if unstable

MONTEGGIA FRACTURE
Giovanni Monteggia 1814 Fracture of Ulna Dislocation of radial head within the elbow joint

Treatment: Surgery

RADIAL HEAD
Most common part broken in elbow fracture MC caused by fall onto outstretched hand +/- surgery depending on displacement

GALEAZZI FRACTURE
Fracture of Radius Injury of the distal radio-ulnar joint of wrist (shortening and dislocation of distal ulna) Mechanism: fall on outstretched hand with elbow flexed Treatment: Surgery to repair radius, then inspection of distal radio-ulnar joint

NURSEMAIDS ELBOW
Common in young children (< 5 yo) Subluxation of radius at elbow joint -bone has slid out of proper position Classically a sudden pull on childs arm Present with arm flexed a/g body If treated (replaced) quickly, immobilization is not necessary For multiple subluxations, cast to allow ligaments to heal

SMITHS FRACTURE
Fracture of radius near the wrist joint Displaced anteriorly (in front of normal position) MC found after falling on to the back of the hand

Treatment: Requires fixation

COLLES FRACTURE
Fracture of radius Displaced posteriorly (behind normal position) MC after fall onto outstretched hand Treatment: Cast +/- surgery, depending on shortening and displacement of radius

SCAPHOID BONE FX
Scaphoid sits below the thumb; shaped like a kidney bean Retrograde blood supply Many are misdiagnosed as sprain May not show up on xray until healing begins (may immobilize empirically and repeat xray in 1-2 wks) May cast for trial period with routine xrays Total healing time of 10-12 weeks

BOXERS FRACTURE
Classically at the base of 5th metacarpal (metacarpal neck) Seen after punching person or object Commonly a bump over the back of palm just below the small finger knuckle; may not go away even with treatment Treatment: casting or surgery (pins)

BENNETTS FRACTURE
Intra-articular fracture/dislocation of base of 1st metacarpal Small palmar fragment continues to articulate with trapezium Mechanism: forced abduction of thumb

Treatment: open reduction and internal fixation

ROLANDO FRACTURE
Fracture through thumb metacarpal base Comminuted intraarticular fracture

Prognosis is worse than Bennetts Treatment: open reduction and internal fixation

INTERTROCHANTERIC HIP FX
Occurs lower than femoral neck fracture Bone blood flow is usually intact, so repair, not replacement is performed Treatment: Metal plate and screws

FEMORAL NECK FRACTURE


Just below the ball of the ball-and-socket hip joint The ball is disconnected from rest of the femur Blood supply is often disrupted, so theres a high risk of non-healing

Treatment: Often with partial hip replacement, esp if > 65 yo

FEMORAL SHAFT FX
Severe injury Treatment: Intramedullary rod (MC), plate and screws, or external fixator

SUPRACONDYLAR FEMUR FX
Unusual injury just above knee joint High risk of knee arthritis later More common in pts with severe osteoporosis and those with previous knee replacement surgery

Treatment: Cast, brace, external fixator, plate, screws, intramedullary rod

PATELLAR FRACTURE
Fall onto kneecap or when quadriceps is contracting, but knee joint is straightening (eccentric contraction) Attempt straight leg raise
yes? Non-operative treatment may be possible no? surgery combo of pins, screws, and wires

TIBIAL PLATEAU FRACTURE


Just below knee joint Involves the joint cartilage risk of arthritis

Treatment: If non-displaced, may be treated without surgery. Surgery for displaced fractures

TIBIAL SHAFT FRACTURE


Most common type of tibial fracture Most can be treated by long leg cast May require plates, screws, external fixator, or intramedullary rod

TIBIAL PLAFOND FRACTURE


Tibial Pilon Fracture End of shin bone and involves ankle Soft-tissue around ankle may be problematic if very swollen makes surgery difficult Treatment: casting, external fixation, limited internal fixation, internal fixation, ankle fusion

POTTS FRACTURE
Fracture of the lower end of fibula with displacement of tibia Causes the foot to turn out

TALUS FRACTURE
Complications: Ankle arthritis Subtalar arthritis Foot deformity Avascular necrosis

CALCANEUS FRACTURE
Fall from heights or MVC Like an orange if you stand on it, the calcaneus widens and squashes flat Inversion and eversion are affected (subtalar joint b/w talus and calcaneus)

FRACTURES OF 5th METATARSAL


Avulsion: Dancers fracture; tiny flecks of bone are pulled off by attached tendon; heal well in cast Jones: occurs at proximal end (in midportion of foot); cast for 6-8 wks

Avulsion (Dancers)

Jones fracture

TORUS FRACTURE
Buckle fracture Compression fracture of a long bone, mostly in children; usually occurs near metaphysis Better seen on lateral films Distal radius is most common site Treatment: well-fitting immobilizing cast for 2-4 weeks

GREENSTICK FRACTURE
Usually from a quick twisting motion occompanied by axial compression such as a fall backwards on the outstretched hand Supinated twist palmar angulation Pronated twist dorsal angulation No disruption of cortex; may have buckling on opposite side of bone from the break; incomplete break

THE END
(FINALLY!!!!)