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Definitions
Fracture
A disruption in all or part of the cortex of a bone All = complete Part = incomplete = children
Complete 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
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Subluxation
The bony components of a joint are partially in contact with each other There is partial disruption of the joint
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Incomplete Fractures
Transverse perpendicular to the long axis of the bone Caused by a force perpendicular to shaft
Diagonal or oblique caused by a force usually applied in the same direction as the long axis of the bone
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Spiral a twisting fracture caused by a torque injury such as planting the foot in a hole while running
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 case
Lateral 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 fractured
Medial Lateral
Shortening
Overlapping of the ends of the fracture fragments Shortening is usually described by the number of centimeters of overlap
Medial Lateral
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
2 3
Simple
Comminuted
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 comparison
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Salter-Harris Classification
Type II fracture of the metaphysis and the epiphyseal plate Most common type of Salter fracture Corner-sign small metaphyseal fragment
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Salter-Harris Classification
Type III Fracture of the epiphyseal plate and the epiphysis
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Salter-Harris Classification
Type IV Fracture through the metaphysis, epiphyseal plate and the epiphysis Poorer prognosis i.e. premature closure of epiphysis
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Smiths fracture fracture of the distal radius with palmar angulation Fall on a flexed hand
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Boxers fracture fx head 5th metacarpal with palmar angulation Most often the result of punching a person or wall
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Scaphoid fractures Buckle fractures of radius/ulna Radial head fracture Supracondylar fractures in children Posterior dislocation of the shoulder Hip fractures
Scaphoid fractures common Pain in anatomical snuff box Fall on outstretched hand Can lead to avascular necrosis
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Buckle fractures of radius/ulna Children Look for angulation of cortex Heal quickly
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Posterior dislocation of the shoulder Humeral head looks like lightbulb Usually need another view like axillary or Y view
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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 fracture
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Jones fracture fracture of the base of the 5th metatarsal Avulsion type fracture frequently caused by pull of peroneus brevis tendon
Fracture Healing
Indistinctness of fracture line Bony callous production Bridging of fracture
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.
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Quiz
Correct 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. Rotated
Answer 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. Rotated
There 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. Spiral
Answer follows
The terms below that best describe this fracture are: 1. Angulated 2. Comminuted 3. Rotated 4. Greenstick 5. Spiral
Answer follows
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 ago
Healing 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.
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I know my Fractures
POR SU ATENCION