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Recognizing fractures

Recognizing fractures. Dr. Ahmed Refaey. FRCR. 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

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Recognizing fractures

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  1. Recognizing fractures Dr. Ahmed Refaey FRCR

  2. Definition • Fracture

  3. Fracture A disruption in all or part of the cortex of a bone All= complete Part = incomplete

  4. Incomplete fracture • Greenstick fracture fracture through one cortex • Torus fracture buckling of the cortex ( buckling fracture)

  5. Torus fracture

  6. Greenstick fracture

  7. 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

  8. By the direction of the fracture line - transverse - diagonal or oblique - longitudinal - spiral

  9. Transverse - perpendicular to the long axis of the bone - caused by a force perpendicular to the bone shaft

  10. Diagonal or oblique - caused by a force usually applied in the same direction as the long axis of the bone

  11. Longitudinal - along the longitudinal axis of the bone

  12. Spiral - a twisting fracture caused by a torque injury such as planting the foot in a hole while running

  13. 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

  14. By the relationship of one fracture fragment to another - displacement - angulation - shortening - rotation * Most fractures display more than one of these abnormalities of position

  15. By convention, abnormalities of position describe the relationship of the distal fracture fragment relative to the proximal fragment

  16. 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

  17. 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

  18. 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

  19. Rotation • Almost always involves long bones ( humerus and femur ) • In this case, Knee joint is in AP position ( points forward) , but ankle points lateral

  20. 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

  21. By the number of fracture fragments - two fragments : simple - more than two fragments : comminuted

  22. By the relation to the adjacent joint - intra-articular - extra-articular

  23. 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

  24. Salter-Harris fracture

  25. 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

  26. Salter-Harris classification • Type I : epiphyseal plate alone • Type II : epiphyseal plate & metaphysis • Type III : epiphyseal plate & epiphysis • Type IV : epiphyseal plate & metaphysis &epiphysis • Type V : crush ( ruined ) fracture of theepiphysealplate

  27. SALTR • S = Slipped growth plate • A = Above (# above growth plate ) • L = Low ( # lower than“below” growthplate) • T = Together ( # of metaphysis+growth plate +epiphysis) • R = Ruined

  28. Salter-Harris classification • Type I - fracture through the epiphyseal plate alone - often difficult to detect without other side for comparison

  29. Salter-Harris classification • Type II - fracture of the epiphyseal plate and metaphysis - most common type of Salter fracture - “corner sign”- small metaphyseal fragment

  30. Salter-Harris classification • Type III - fracture of the epiphyseal plate and the epiphysis

  31. Salter-Harris classification • Type IV : - fracture through the metaphysis, epiphyseal plate and the epiphysis - poorer prognosis “ premature closure of epiphysis “

  32. Common fracture eponymes • Colle’s fracture • Smith’s fracture • Barton’s fracture • Jone’s fracture • Boxer’s fracture • Lover’s fracture

  33. Colle’s fracture - Extra articular fracture of the distal radius with dorsal angulation

  34. Smith’s fracture - extra articular fracture of the distal radius with volar angulation

  35. Smith’s fracture

  36. Smith’s fracture ( reverse colle’s )

  37. Barton’s fracture - intra articular fracture of distal radius

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