How to Describe a Fracture

Question 1

What information on an X-Ray can help in confirming if the X-Ray is of the right person?

Answer 1

• Name
• D.O.B.
• CHI number

Question 2

What is the first information to look at on an X-Ray?

Answer 2

• Right person
• Right time & place
• Right anatomical site
• Right views of the sight

Question 3

When examining a bone on an X-Ray, what characteristic of the bone do you need to focus on?

Answer 3

• Cortical outline
• Cancellous architecture
• Associated soft tissue
• Joints
• Alignment

Question 4

What are the 7 aspects of describing a fracture?

Answer 4

1. Mechanism and energy of injury
2. Skin and soft tissues
3. Site
4. Shape
5. Comminution
6. Deformity
7. Associated injuries

Question 5

What are the rules / requirements for x-rays of fractures?

Answer 5

2 views are needed at 90 degrees to one another (most commonly AP and lateral)

2 joints visible within the radiograph (above and below)

2 bones visible (if appropriate)

2 occasions (eg. necessary for scaphoid fracture bc may only be visible on X-Ray 7-14 days later)

Question 6

What characteristics of the site of a fracture need to be included in your description of a fracture?

Answer 6

• Side (L/R)
• Limb
• Bone(s) involved
• Region
• Articular involvement: intra-articular? +/- Dislocation or subluxation? Ligamentous avulsion? Epiphyseal?

Question 7

What characteristics of the shape of a fracture need to be included in the description of a fracture?

Answer 7

Shape = configuration
- Transverse (straight across - usually direct trauma)

• Oblique (diagonal - usually due to a bending moment of force)
• Spiral (rotational force)
• Complex (multiple forces, usually comminuted)

Question 8

What is comminution?

Answer 8

A comminuted fracture is a break or splinter of the bone into more than two fragments

Question 9

What are the different types of comminuted fractures?

Answer 9

• Butterfly: triangular shaped comminuted piece of bone

- Segmental: long bone is fractured into segments, eg. minimum of 3 segments of the bone

Question 10

What is the “deformity” of a fracture defined as?

Answer 10

The movement of the distal fragment with respect to a supposedly stationary proximal fragment of bone

Question 11

What are the different characteristics of the deformity of a fracture?

Answer 11

• Displacement of the bone & direction (as a percentage of the diameter of the bone)
• Angulation (anteriorly / posteriorly / varus / valgus)
• Rotation (internal / external)
• Axial deformity (lengthening - tissue between ends / shortening - impaction or muscle contraction)

Question 12

What are the most important things to look for when examining the soft tissue of a fracture?

Answer 12

• Air (open fractures / gas forming organisms)
• Foreign bodies
• Fluid levels