Tension causes what kind of fx?
transverse
Compression causes what kind of fx?
oblique
Rotaion causes what kind of fx?
spiral
Angulation causes what kind of fx?
transverse
Angulation + compression causes what kind of fx?
transverse & oblique
What type of fracture is common in pathologic bone conditions?
transverse fx
What is apposition and how is it described?
- closeness of the bony contact at the fx site
- describe the offset of distal in relation to the proximal
- describe direction
What does alignment describe?
position of distal fragment in relation to proximal dealing with direction and degree of angulation
When is the highest rate of fractures in males?
- 2nd and 3rd decades
- after 65 years
When is the highest rate of fractures in females?
- up to 20 years
- steadily increases at age 45
FOOSH injury in >5years
supracondylar fx
FOOSH injury in 16-35 years
scaphoid or other carpals
FOOSH injury in >40 years
colles fx or ulna fx
FOOSH injury in >70 years
humeral surgical neck fx
What is the MC area of injury in 10-16 year olds?
epiphyseal area since it is teh weakest area of the bone
What are the MC regions of fx in elderly?
- T/L spine
- proximal femur
- distal radius
- proximal humerus
3 phases of healing
- inflammatory or circulatory phase
- reparative or metabolic phase
- remolding phase
What is clinical union?
when the callus is sufficiently developed to allow weight bearing or similar stress
What is the MC type of Salter-Harris fx?
Salter type II
-physis + metaphysis
What is the LC type of Salter-Harris fx?
Salter type V
-compression of physis
What is another name for Salter type II fx?
Thurston - Holland Sign
Which Salter type fxs produce an intra-articular fx?
Satler III and IV
What is the normal AC joint width?
<5mm (<2-3mm bilateral difference)
What is the normal distance b/w coracoid and clavicle?
11-13mm (<5mm bilateral difference)
What is the MC type of clavicle fx?
middle third (80%)
What is a Flap fx?
avulsion fx of the greater tuberosity of humerus
What is the MC humeral fx?
surgical neck fx
What are the 3 subcategories for anterior shoulder dislocations?
- subcoracoid (MC)
- subglenoid
- intrathoracic
What is the name for an impaction fx of the humeral head associated with an anterior dislocation?
Hill-Sach’s lesion
What is the name for an avulsion of the inferior glenoid rim associated with an anterior dislocation?
Bankart lesion
What are some characteristics of a posterior shoulder dislocation?
- widening of joints space (>6mm, rim sign)
- double articular surface (trough line sign)
- tennis racquet appearance
- fixed internal rotation
What is luxatio erecta?
an inferior shoulder dislocation
Radiology of rotator cuff tears
- acromiohumeral joint narrowing (<6mm)
- erosion of inf. aspect of acromian
- flattening/atrophy of greater tuberosity
What two lines are used as assessment tools in a lateral elbow view?
- anterior humeral line
- radio-capitellar line
What is the order of ossification for the elbow?
-capitellum
-radial head
-internal/medial epicondyle
-trochlea
-olecranon
-external/lateral epicondyle
(1-3-5-7-9-11)
What age does Nursemaids Elbow occur?
2-5 years
How is Nursemaids elbow reduced?
with supination
What is the 3rd MC dislocation in adults?
elbow joint
What is the 2nd MC dislocation in adults?
interphalangeal joints
What is the MC dislocation in adults?
shoulder
What is the MC direction of elbow dislocations?
posterior/posterolateral
What is another name for a minimally displaced oblique fracture of the distal ulnar shaft?
nightstick fx
What is a Galeazzi’s Fx?
fx of the distal radius with dislocation of the distal radioulnar articulation
What is a Monteggia Fx?
fx of the proximal ulna with dislocation of the proximal radioulnar articulation
What is another name for a greenstick fx?
hickory stick fx
What is the MC forearm fx in a child?
torus fx
What view best shows a torus fx?
lateral view
What is another name for a torus fx?
buckle fx
What is the normal tilt of the distal forearm?
10-15 degrees anterior (volar)
What are some characteristics a Colle’s fx?
fx of the distal radius with posterior angulation of the distal fragment
What are some characteristics of a Smith’s fx?
fx of distal radius with anterior (volar) angulation of the distal fragment
What is a Barton’s fx?
fracture of the posterior rim of the radius with carpal dislocation
-best seen on lateral view
What is a Hutchinson’s/Chauffeur’s fx?
fracture of the radial styloid process
-best seen on AP view
What is another name for Chauffeur’s fx?
backfire fx
Which is the MC injured carpal?
scaphoid
What part of the scaphoid is MC injured?
waist
Where is the MC site for an occult fx?
scaphoid
What should you do if you suspect an occult fx?
- immobilize wrist and repeat x-rays in 7-10 days
- if in an athlete: order MRI or bone scan
How do you elongate the scaphoid on films?
take film with ulnar flexion
What is the 2nd MC carpal fractured?
triquetral (usually avulsion)
Triquetral fx are only seen in which film?
lateral view
What is another name for triquetral fx?
fisher’s fx
hyperflexion injury
Which the 3rd MC carpal fx?
hamate (hook)
Which is the MC type of carpal dislocation?
perilunate dislocation
Which way are perilunate dislocations MC displaced?
dorsally
What is the 2nd MC carpal dislocation?
lunate dislocation
hyperextension injury
What sign is associated with a lunate dislocation?
pie sign
What are two signs associated with a rotatory subluxation of the scaphoid?
- signet ring sign
- Terry Thomas sign
What is a Boxer’s fx?
fracture of the neck of the 5th or 4th metacarpal
What is the description of a Baseball or Mallet finger?
avulsion fx of the dorsal aspect of the base of the distal phalanx
What aspect of the 1st metacarpal is MC fractured?
75% involve the proximal portion
What is Bennett’s fx?
an oblique fx at the base of the 1 metacarpal associated with dorsal subluxation of the 1st metacarpal
What is the MC injury to the 1st metacarpal?
Bennett’s fx
What is Rolando’s fx?
a comminuted Bennett’s fx
What are some characteristics of a Gamekeeper’s thumb?
- partial or complete disruption of the ulnar collateral LIG of the 1st MCP joint
- avulsed fragment from base of proximal phalanx
- from repetitive stress
What is another name for Gamekeeper’s thumb?
skier’s thumb = acute injury
What is the MC direction of hand dislocations?
dorsal
What direction is the hip MC dislocated?
posteriorly
Which way does the femur head move in a posterior hip dislocation?
superiorly
What other imaging is needed with hip dislocations?
CT
Which way does the femur head MC move in an anterior hip dislocation?
inferiorly
What is the MC type of hip fractures?
subcapital
What are the 2 types of stress fx?
fatigue and insufficiency
What is the definition of fatigue stress fx?
abnormal stress on a normal bone
repetitive stress
What is the definition of an insufficiency fx?
normal stress on an abnormal bone
What is the MC type of fx seen in the femoral shaft?
transverse mid shaft fx
What is a sign of an intra-articular knee fx?
-FBI sign
==>fat blood interface
On who are anterior tibial spine avulsions MC seen on and where?
- MC seen in children
- occur at the insertion of the ACL
What type of meniscal tear is usually degenerative?
horizontal cleavage
What is a Segond’s fx?
linear fragment near the lateral margin of the lateral tibial plateau
What is commonly associated with a Segond’s fx?
ACL tear (75% of the time)
