General Concepts of SKELETAL TRAUMA Flashcards
Conventional radiography – 2 views at \_\_\_ degrees to one another are crucial for detection of injuries.
90
Computed Tomography (CT) – Great for detecting/assessing \_\_\_\_\_\_\_\_\_ in complex anatomical regions
fractures
Magnetic resonance imaging (MRI) – MRI great for \_\_\_\_\_\_\_\_\_\_\_\_\_ induced internal derangement of joints and soft tissues (including the spinal cord and nerves)
traumatically
Mechanism of injury – The mechanism of injury is a major factor in the \_\_\_\_\_\_ of injury that will result.
____________=
– Is simply
a break in the continuity of bone or
cartilage or both
TYPE
Fracture
Fracture descriptions
1– Complete Fractures
• Occurs when the entire circumference of bone is
disrupted.
• Certain orientations depending on forces applied
2– Apposition
• The degree of bone contact at the fracture site
between the fragments.
3–– Angulation
• Angulation of the distal fragment is described in
relation to the proximal one
4–– Rotation
• Rotational displacement of
a fracture (about the long axis of a bone) can be extremely difficult to visualize
with conventional radiographs.
5--– Intraarticular • If the fracture extends INTO the joint this is important to identify
KNOW
TYPES OF FRACTURES
1—Incomplete:
• Involves only PART of the cortex
(seen most often in children, in the distal ______).
– greenstick
– torus
– stress (technically some may be, but they are not
often classified here)
2–Impaction fracture
– Results when one fragment of bone is driven INTO
an apposing fragment.
– _______________, hard bone into softer bone
– _______________, articular surface into articular
surface
– Both present a radiodense defect.
radius
Depression
Compression
SLIDE 31
TYPES OF FRACTURES
3–Stress fracture
– Occur in normal or abnormal bone that is
subjected to repeated cyclical loading, with the
load being less than that causing acute fracture
of bone.
Two types
– ______________ fractures
• Normal stress on abnormal (osteopenic) bone
–____________ fractures
• Abnormal stress on normal bone
– Present a radiodense defect
4–Pathologic fracture
– Is one in which the bone is disrupted at a site of
preexisting __________
Insufficiency
Fatigue
abnormality
TYPES OF FRACTURES
5—Avulsion fracture
– Occurs when an ________ ________ is pulled from
the parent bone by a tendon or ligament
6–Occult fracture
– Fracture is NOT visualized on conventional
radiography
7---Salter‐Harris fractures – A fracture that involves the physis – Five basic types ---SLIDE 45 --#2 is most common w/THURSTON HOLLAND
8—Bone Bruise
– Compressive forces resulting in trabecular
microfractures with edema, hemorrhage and
NECROSIS in the marrow.
– Only seen on _____
• low signal on T1‐WI
• high signal on T2‐WI
osseous fragment
MRI:
FRACTURE HEALING • Three phases: 1– inflammatory 2– reparative 3– remodeling • Each phase is a \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_ of the previous phase.
gradual continuation
FRACTURE HEALING–PHASE 1–INFLAMMATORY
PHASE
—3 stages:
cellular (10 days)
vascular (10 days)
1° callus (10 days)
STAGE 1-----------Cellular: – hematoma and \_\_\_\_ \_\_\_\_\_\_\_\_\_ note: the hematoma (should NOT be disturbed) – inflammatory response, granulation tissue
clot formation
FRACTURE HEALING–PHASE 2 AND PHASE 3
INFLAMMATORY
STAGE 2 = Vascular:
– formation of vascular spindle leads to hyperemia,
which leads to increased _________ activity
STAGE 3 = • 1° Callus:
– callus formation begins
– fracture line becomes hazy, _______
– early callus usually not seen on x‐ray
osteoclastic
widens
FRACTURE HEALING: REPARATIVE = PHASE 2 • Last for WEEKS • More \_\_\_\_\_\_ • Callus formation: – sealing, bridging, buttressing, uniting • Osteoid replaced with more MATURE bone • Fracture usually STABLE by end of this stage
orderly
FRACTURE HEALING: REMODELING = PHASE 3 • Lasts months to YEARS • New bone is laid down along lines of stress • Unnecessary bone is REMOVED • \_\_\_\_\_\_ \_\_\_\_\_\_\_ restored • The x‐rays may appear normal, but a bone scan may still be warm
Marrow cavity
COMPLICATIONS OF TRAUMA:
= IMMEDIATE
• Occurs within HOURS – \_\_\_\_\_\_\_ injury – Fat EMBOLI/ thromboembolism ***Lipohemarthrosis – \_\_\_\_\_\_\_\_\_\_ syndromes – \_\_\_\_\_\_\_\_\_\_ injury
Vascular
Compartment
Neurologic
COMPLICATIONS OF TRAUMA:
= INTERMEDIATE
• Occurs in DAYS TO WEEKS – Osteomyelitis – Disuse osteoporosis – Complex regional PAIN syndrome (RSDS) – Post traumatic osteolysis – \_\_\_\_-\_\_\_\_\_\_\_\_ – MYOSITIS OSSIFICANS – Synostosis – \_\_\_\_\_\_\_ union
Re‐fracture
Delayed
