Transcript fracture
Definition • Fracture Fracture A disruption in all or part of the cortex of a bone All = complete Part = incomplete Incomplete fracture • Greenstick fracture fracture through one cortex • Torus fracture buckling of the cortex ( buckling fracture) Torus fracture Greenstick fracture How fractures are described • By the direction of the fracture line • By the relationship of the fragments • By the number of fragments • By relation to the adjacent joint • By the direction of the fracture line - transverse diagonal or oblique longitudinal spiral • Transverse - perpendicular to the long axis of the bone - caused by a force perpendicular to the bone shaft • Diagonal or oblique - caused by a force usually applied in the same direction as the long axis of the bone • Longitudinal - along the longitudinal axis of the bone • 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 direction of the fracture line • By the relationship of the fragments • By the number of fragments • By relation to the adjacent joint • By the relationship of one fracture fragment to another - displacement angulation shortening rotation * Most fractures display more than one of these abnormalities of position • By convention, abnormalities of position describe the relationship of the distal fracture fragment relative to the proximal fragment Displacement • The amount of offset of the distal fracture fragment relative to the proximal • There is lateral displacement of the distal femoral fracture fragment in this case 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 Shortening • Overlapping of the ends of the fracture fragments • Shortening is usually described by the number of centimeters of overlap • There is also medial displacement here Rotation • Almost always involves long bones ( humerus and femur ) • In this case, Knee joint is in AP position ( points forward) , but ankle points lateral How fractures are described • By the direction of the fracture line • By the relationship of the fragments • By the number of fragments • By the relation to the adjacent joint • By the number of fracture fragments - two fragments : simple - more than two fragments : comminuted • By the relation to the adjacent joint - intra-articular - extra-articular How fractures are described • By the direction of the fracture line • By the relationship of the fragments • By the number of fragments • By the relation with the adjacent joint Salter-Harris fracture Salter-Harris fracture • 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 I and II do well - type IV and V can develop early fusion of epiphysis and shortening of that bone Salter-Harris classification • Type I • Type II • Type III • Type IV • Type V : epiphyseal plate alone : epiphyseal plate & metaphysis : epiphyseal plate & epiphysis : epiphyseal plate & metaphysis & epiphysis : crush ( ruined ) fracture of the epiphyseal plate SALTR • S = Slipped growth plate • A = Above (# above growth plate ) • L = Low ( # lower than “below” growth plate) • T = Together ( # of metaphysis+growth plate + epiphysis) • R = Ruined Salter-Harris classification • Type I - fracture through the epiphyseal plate alone - often difficult to detect without other side for comparison Salter-Harris classification • Type II - fracture of the epiphyseal plate and metaphysis - most common type of Salter fracture - “corner sign”- small metaphyseal fragment Salter-Harris classification • Type III - fracture of the epiphyseal plate and the epiphysis Salter-Harris classification • Type IV : - fracture through the metaphysis, epiphyseal plate and the epiphysis - poorer prognosis “ premature closure of epiphysis “ Common fracture eponymes • Colle’s fracture • Smith’s fracture • Barton’s fracture • Jone’s fracture • Boxer’s fracture • Lover’s fracture • Colle’s fracture - Extra articular fracture of the distal radius with dorsal angulation • Smith’s fracture - extra articular fracture of the distal radius with volar angulation Smith’s fracture Smith’s fracture ( reverse colle’s ) • Barton’s fracture - intra articular fracture of distal radius • Jone’s fracture - Fracture of base of 5th - metatarsal bone Avulsion type fracture frequently caused by pull of peroneus brevis tendon • Jone’s fracture - fracture base of 5th metatarsal bone • Boxer’s fracture - fracture head of 5th metacarpal with palmer angulation - most often the result of punching a person or wall • “ Lover’s fracture “ • “ Don joun fracture” • Jumper’s fracture • fracture of the calcaneus and a • dorso-lumbar spine fracture. This is called a 'jumpers fracture' or a 'lover's fracture', because it is usually seen in people jumping out of a window to escape from the police or a jealous husband. Easily missed fractures • Scaphoid fracture • Buckle fracture “ torus “ • Radial head fracture • Supracondylar fracture in children • Scaphoid fracture - common - pain in anatomical snuff box - fall in outstretched hand - can lead to avascular necrosis • Buckle “ Torus “ fracture - children - Look for angulation of the cortex - Heal quickly • Radial head fracture - Common - Fat pad sign Supracondylar fractures in children • Fat bad sign • Posterior displacement of capitulum “ anterior humeral line “ Anterior humeral line Quiz Torus fracture Greenstick fracture Smith’s fracture Salter-harris IV Salter-Harris type IV AVN of scaphoid Salter-Harris fracture type I Salter-Harris type III Slipped capital femoral epiphysis “ Salter-Harris type I “ Salter-Harris type II Salter-Harris type III Lover’s ( Don joun) ( Jumper’s) fracture