Transcript Types of fractures – text pg 30

Reviewing: Epiphyseal Plates (younger skeletons)
eventually will disappear. Bones grow lengthwise up
and down from each plate, and in a circular ‘collar
like ‘fashion around the diaphysis. These plates will
become thin lines and be virtually undetectable in an
adult long bone
EPIPHYSEAL PLATE IN FEMUR
Sites for bone marrow testing,
removal or implantation
Biopsy needle inserted through: periosteum,
compact bone into red marrow/spongy bone
below
Bone marrow from donor to
recipient
Examples of fractures – text pg 30
Types of Fractures:
• 1. Simple Fracture – no separation of the bone into parts,
but a crack or break is detectable; aka hairline (very faint
crack) – bone is NOT exposed to air through skin –
Cause?? Fall, body contact, impact
• 2. Compound Fracture – the bone breaks into 2
separate pieces; bone may be exposed through the skin
in serious fractures – Cause?? Major blow (e.g.Bad slide
tackle..) or bad angles into contact
• 3. Comminuted Fracture – the broken ends of the bone
are shattered into many pieces - cause?? Car accident or
major fall from height – need lots of speed or force into
impact
Shapes of Fractures
•A word may be used to describe the shape of the fracture eg.
Transverse ‘straight across’; greenstick /oblique ‘angled’
spiral ‘S shape’/twirl;
A simple fracture of the right tibia –
no broken skin, bone intact
Forearm Fracture – Simple
Comminuted Fractures - fibula is broken
at both proximal/head and distal end and
tibia is badly shattered
Hairline fracture of the 3rd metatarsal
– often need more than 1 x-ray [and
view] to diagnose
Comminuted of the first metacarpal
(thumb!!) – also note appearance of
sesamoid bone on thumb – distal end of
1st metacarpal
A difficult bone to break – the
humerus !
Compound fracture of distal end of fibula –
lateral malleolus would be ‘wrong’ looking –
landing from height with lots of eversion?? Or
tackle from side right against lateral leg??
Theisman?? Ski boot injury??
A compound fracture of distal
humerus in a child
Proximal humerus requires
immobilization
Bad, bad compound fracture of
distal end of Tibia!!!
A beginning to be healed
compound fracture – stapling
may be used to close wound
Collisions with the leg and a planted foot
can have serious implications on the tibia
and fibula depending on where the contact
comes from.
Comminuted/shattered fracture of fibula –
skiing injury?? Also, appears to a fracture of
distal tibia at the medial malleolus – a chipped
off piece of bone is called an avulsion fracture
The femur is one of the most
difficult bones to fracture – car
accidents, falls from height etc..
Falls on the outstretched arm usually fracture:
the radius, the scaphoid (carpal bone) or the
first metacarpal (thumb)
Causes of fractures…
• Bone
• Bones can be fractured following collisions, falls and impacts.
Typically, the signs of a fracture are swelling, tenderness,
bruising, restriction of movement and, in some instances,
obvious deformity.
• Fractures are potentially serious injuries and a considerable
amount of blood can be lost either externally (if the skin is
broken) or internally (when the skin is unbroken, known as a
closed fracture). Loss of blood can lead to physiological shock.
The surrounding soft tissues are often also damaged.
• Treatment by a suitably qualified individual involves controlling
the bleeding, preventing further damage or movement (by
splinting if appropriate) and transporting the person to hospital,
treating for potential shock on the way. Even if a fracture is only
suspected, medical assessment is still necessary. The
manipulation of a displaced fracture is for the medically
qualified.
Sports with legal body contact such as
tackling (rugby, football) hockey (checking)
may have upper body fractures, separations or
dislocations
Separation – refers to the clavicle
moving away from either the
coracoid process or acromion
process of the scapula
Dislocation – bone is displaced
from its original location
• Most common is finger, shoulder or
kneecap
• Dislocations can tear ligaments and the joint
capsule
This looks painful! Shoulder or
Elbow dislocation perhaps??
Treating fractures: immobilize, ensure alignment,
proper nutrition during healing, prevention of
infection if compound!
•
Healing: Text pg 30
- if bones are not aligned – they need to be put
into alignment – this can be done with or without
pain management – nasal bone fractures
- use of plates, screws etc.. in serious cases – these
usually stay in forever!
-if bone heals in a misaligned fashion it needs to
be rebroken – can be very traumatic
- bone chips can be used from other parts of body
to facilitate healing
- Calcium, Vitamin D, phosphorous and Vitamin A
and C are all thought to aid bone healing
• Common sports injuries
• Articular cartilage injuries - injuries to the surfaces of the bones where they
come together to form joints (articular cartilage, a material that allows the
bone surfaces to glide smoothly across each other). Chronic wearing down of
this material is called osteoarthritis. A chondral or osteochondral fracture
occurs when a fracture of the bone involves both bone and cartilage.
• Children's Memorial Institute for Sports Medicine provides care for
competitive athletes of all disciplines.
• Avulsion fracture - a fracture where a tendon pulls off a piece of bone,
usually as a result of a violent or forceful muscle contraction. In children and
adolescents, an avulsion fracture typically occurs at a growth center (an area
of the bone made up of cartilage which is also the site where tendons attach
to bone).
• Dislocation - when a joint comes fully out of the socket and needs to be put
back in place.
• Exercise-induced asthma - not the same as chronic asthma, the more proper
term is exercise-induced bronchospasm (EIB). EIB is shortness of breath and
wheezing that are triggered by exercise or physical activity. The symptoms
usually occur during or shortly after exercise.
• Growth plate injuries - injuries to the cartilage found at the ends of the
bones in children and adolescents. Cartilage is softer than bone and therefore
more vulnerable to injury. Growth plate injuries include fractures and
avulsions.
• Heat illness - illness resulting from excessive exercise in high
temperature or humidity.
• Ligament injuries - include sprains (stretched or partially torn) and
complete tears or ruptures to the pieces of fibrous tissue that connect
one bone to another -- the ligaments.
• Meniscus injuries - injuries to the crescent-shaped rubbery wedge of
fibrous cartilage -- the meniscus - which is located between the
shinbone (tibia) and the thigh bone (femur). The meniscus acts as a
cushion for the knee joint and helps to stabilize the knee during
twisting motions. Injury to the meniscus results in a tear.
• Minor fractures - a crack or break in a bone.
• Stress fracture - overuse injury of a bone that results when too much
stress is placed on it, causing its cortex (outside layer) to crack.
• Tendonitis - inflammation in a tendon which typically results from
overuse.
• Tendon injury - partial or complete tear of a tendon.
• Overuse injuries - Tissue breakdown due to repetitive activity.
Overuse injuries cause pain that worsens over time.
• Sports-related concussion - A traumatic head injury that is
characterized by various physical symptoms, the most common of
which are headaches and dizziness, and is also associated with changes
in brain function, such as memory loss, difficulties with attention,
processing speed, reaction time, and concentration.
Bad, bad compound fracture of
both radius and ulna!!
Looks like a compound fracture
of distal end of tibia!!