(1,3) Intro to Trauma Flashcards by Lindsay Kirkpatrick

What is an open fracture?

Fx that breaks the skin
(AKA compound Fx)

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What is the clinical significance of an open fracture?

concern for infection (osteomyelitis)

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What is a closed fracture?

Fx does not break skin

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What is a comminuted fracture?

1 bone in 3 or more pieces

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What type of fracture is associated with a butterfly fragment?

comminuted

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What is a segmental fracture?

single bone is broken in multiple places (comminuted), separating a segment of bone

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What is an avulsion fracture?

tearing away of bone fragment by ligament/tendon/muscle

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What is the term for the site where a tendon/ligament plugs into a bone?

enthesis

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What is an impaction fracture?

portion of bone is driven into adjacent segment, appearing as white line instead of black radiographically

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Name 2 location-specific diagnoses of impaction fractures

compression Fx (vertebral body, calcaneus)
depressed Fx (tibial plateau, frontal bone)

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Name 2 types of stress fractures

fatigue Fx
insufficiency Fx

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What causes a vertical/longitudinal fracture?

convex meets concave, causing concave to fail longitudinally

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What is a pathologic fracture?

Fx through diseased, weakened bone

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What is the most common orientation of pathologic fractures?

transverse

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What is the term for spontaneous collapse of a vertebral body, creating the appearance of a flattened vertebral body?

vertebra plana
(patho Fx)

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What is a fatigue fracture?

abnormal stress on normal bone, resulting in mechanical failure

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What is an insufficiency fracture?

normal stress on abnormal bone, resulting in mechanical failure
(form of pathologic Fx)

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What is the radiographic latent period in the extremities?

7-10 days

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What is the radiographic latent period in the spine?

21 days

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What are the possible radiographic findings of a stress fracture?

soft tissue swelling
solid periosteal lifting
white line (callus) perpendicular to wt-bearing trabecula

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What are your next steps if you suspect a stress fracture in the 5th metatarsal, but radiographs look normal 5 days post-injury?

if not vital, rest & re-x-ray in 2wks
if vital, MRI or bone scan

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What are the advantages of MRI?

more specific
allows soft tissue evaluation
no radiation

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What is the “Honda sign?”

vertical ala + horizontal upper sacral insufficiency Fx
(eg. elderly pt w/ SI pain not getting better w/ adjustments)

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What is a pseudofracture?

not a true Fx; zones of unmineralized osteoid which appears as radiolucent line transverse to long bone axis (dark line part of the way through bone)

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What are other names for pseudofracture?

- looser lines - milkman syndrome - umbau zonen

What is the list of differential diagnoses for pseudofracture?

Paget disease Rickets Osteomalacia Fibrous dysplasia

What is an occult fracture?

radiographically invisible Fx

What are the most common sites of occult fractures?

1. scaphoid 2. tibia 3. ribs

What is a stable fracture?

does not (or unlikely to) move during healing process

What is an unstable fracture?

possibility of progressive biomechanical failure (movement) or neurologic insult (spinal)

What is mechanism of a transverse fracture?

shear (MC) pathologic tension

What is orientation of a transverse fracture?

perpendicular to long axis of bone

What is mechanism of an oblique fracture?

compression

What is orientation of an oblique fracture?

30-60 degrees to long axis of bone

What is mechanism of a spiral fracture?

rotation

What is orientation of a spiral fracture?

60-89 degrees to long axis of bone (pointed end)

What is a bone contusion?

hemorrhage, edema, microfracture of bone (hurts like a Fx, treated w/ rest)

How is a bone contusion visualized?

MRI (not visible on xray)

What are kissing contusions?

bruising of 2 bones that run into each other

What type of effusion is more important clinically?

intra-articular (joint) effusion

What is a lipohemarthrosis?

liquid marrow leaking out of bone

What is the FBI sign?

(Fat-blood interface) dark transverse line representing marrow fat floating on top of blood that hemorrhages into joint capsule

What 2 things are necessary to be able to see an FBI sign on x-ray?

- intracapsular Fx - x-ray beam parallel to floor (not pointed at floor)

What is another name for the anterior fat pad sign of the elbow?

Sail sign

The "sail sign" is (sensitive/specific) for ____

sensitive for intracapsular Fx

The posterior fat pad sign is (sensitive/specific) for ____

specific for intracapsular Fx

What must be ruled out first if you find a transverse fracture?

patho Fx

How are tubular bone fractures described?

- alignment/angulation - apposition (degree of bone contact) - rotation (about long axis)

What are the 4 types of joint injury?

- subluxation - dislocation - diastasis - osteochondral Fx

What is subluxation?

- damaged lig. at least partially but less than dislocation - still have contact of articular (hyaline) surfaces

What is dislocation?

complete loss of contact between articular (hyaline) surfaces of a joint

What are your next steps for a dislocation?

immobilize & send to ER

What type of joint does dislocation occur in?

synovial

What type of joint does diastasis occur in?

fibrous (syndesmosis)

What is diastasis?

displacement or frank separation of a slightly moveable joint (syndesmosis)

What is an osteochondral fracture?

fracture through joint surface

What is another name for osteochondral fracture?

osteochondritis dissecans (OCD)

What are the most common locations of osteochondral fractures?

- lateral aspect of medial femoral condyle (w/ ACL inj) - talar dome - capitulum

Most osteochondral fractures require what type of imaging?

MRI arthrogram

What is Bayonet apposition?

0% contact at Fx site, instead run together lengthwise

How do you name a dislocation?

direction/plane + joint + "dislocation"

Name 2 categories of pediatric specific injuries.

- incomplete fractures - physeal injuries (NOT diagnoses)

Name 2 types of incomplete fractures in children.

- torus Fx - greenstick Fx

What is the mechanism of a torus fracture?

compressive force (buckles cortex)

What is the mechanism of a greenstick fracture?

angular force (breaks part way through)

When would you suspect a salter harris fracture?

anytime a pediatric pt has physeal plate tenderness

What are the 5 types of Salter Harris fractures?

1 = Slipped (through physis, often w/ slippage) 2 = Metaphysis + physis 3 = Epiphysis + physis 4 = Bi (both metaphysis + epiphysis + physis) 5 = crunch (crushing)

What type of Salter Harris fracture is associated with a Thurston Holland fragment?

type 2

What is the most common type of Salter Harris fracture?

type 2

What type of Salter Harris fracture appears radiographically normal?

type 5

What are 2 specific/named type 2 Salter Harris fractures?

- SCFE (prox. femur) - Gymnast Fx (distal radius)

Describe the typical patient with a slipped capital femoral epiphysis.

- 10-15 yrs - obese - M > F - left > right

How often are SCFE injuries found bilaterally?

20-30%, usually within 1 year of first Dx (F>M)