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Intro to Fracture Flashcards

Including pediatric specific injuries (88 cards)

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1
Q

Butterfly fragment and segmental fracture are both examples of ___ fracture.

A

comminuted

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2
Q

If a butterfly fragment is seen, you can assume the causative force was ___.

A

perpendicular to the axis of the bone

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3
Q

Segmental fractures follow the ___ principle.

A

Pretzel principle

it’s hard to break a ring structure in just one place
look for other breaks in a ring structure

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4
Q

If a ligament, tendon, or muscle has torn away a bone fragment, what type of fracture has occurred?

A

Avulsion fracture

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5
Q

What is a compression fracture?

A

Vertebral body fractures by impaction into a wedge-shape
In another example, the calcaneus can be crushed by axial force

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6
Q

What is a depressed fracture?

A

Flat bones fracture by impaction
e.g. tribial plateau, frontal bone

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7
Q

What is an impaction fracture?

A

Portion of bone is driven into the adjacent segment, loading the axis of a bone and breaking it

exceptions:

  • vertebral body impaction = compression
  • tibial plateau or frontal bone impaction = depressed
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8
Q

How might an impaction fracture appear on an x-ray?

A

White zone of impaction due to fracture fragments overlaying

may be able to walk on it and make it worse

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9
Q

How does a vertical/longitudinal fracture occur?

A

When a convex surface meets a concave articulation, the concave surface fails

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10
Q

What is pathologic determinism?

A

A fracture or trauma reveals a pre-existing pathology

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11
Q

Pathologic fracture occurs through diseased, weakened bone, frequently with ___ orientation.

A

transverse

e.g. banana fracture with Paget

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12
Q

What is vertebra plana?

A

Flat/pancake vertebral body due to pathological fracture

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13
Q

stress fracture

What is a fatigue fracture?

A

Abnormal (repetitive) stress on normal bone resulting in mechanical failure

gradual formation of microfracture e.g. shin splints

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14
Q

stress fracture

What is an insufficiency fracture?

A

Normal stress on abnormal/diseased bone resulting in mechanical failure

form of pathologic fracture

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15
Q

stress fracture

What are the most common sites of fatigue fracture?

A

Mostly lower extremities in runners

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16
Q

Stress fractures have a latent period since day of onset of pain where they are radiographically occult.
This period is ___ in the extremities, and ___ in the spine.

A

7-10 days in extremities
21 days in the spine

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17
Q

After the latent period where the fracture is radiographically occult, what are the radiographic findings of a stress fracture?

A
  • Soft tissue swelling
  • Periosteal lifting (due to blood vessel hemorrhage)
  • White line perpendicular to weight bearing trabecula

must finish inflammatory stage to see hazy white line perpendicular to the force axis of the bone

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18
Q

If the stress fracture isn’t vital, you should ___.
If the fracture is vital, ___.

fracture is at first, occult

A

fracture isn’t vital, rest and re-x-ray in 2 weeks
fracture is vital, MRI or bone scan can be used

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19
Q

How does MRI compare to x-ray and bone scan when looking for vital radiographically occult stress fractures?

A
  • More specific
  • Allows for soft tissue evaluation e.g. bone marrow edema
  • No radiation

soft tissue information makes MRI more useful than bone scan

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20
Q

Patient has bilateral vertical sacral ala fractures and a horizontal upper sacral fracture, all due to insufficiency.
What is the term for this presentation?

A

Honda sign

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21
Q

What is a pseudofracture?

A

Not a true fracture
Uncalcified region of osteoid appearing as a radiolucent line transverse to the long bone axis (not usually all the way through)

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22
Q

What is the differential diagnosis for pseudofractures?

A

PROF:

  • Paget disease
  • Rickets
  • Osteomalacia
  • Fibrous dysplasia
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23
Q

What are the most common sites of occult fracture?

A
  • Scaphoid
  • Tibia
  • Ribs

pinpoint/focal pain is more indicative of fracture than soft tissue injury

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24
Q

What is bone contusion?

A

Hemorrhage, edema, and/or trabecular microfracture not seen on radiographs

MRI necessary

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25
What is the term for two bone contusions existing next to each other?
Kissing contusions
26
How can swelling, effusion, and edema serve as soft tissue evidence of trauma?
Location: Intracapsular edema indicates bone broken within joint capsule Extra-articular edema indicates break outside joint
27
How can lipohemarthrosis serve as soft tissue evidence of trauma?
FBI sign (fat blood interface) means the bone is broken whether you can see it or not | not just fat pad distention
28
Which of the following is more associated with internal derangement: intracapsular effusion or lipohemarthrosis?
Intracapsular effusion | bone is broken within joint capsule
29
What is joint effusion?
Fluid existing outside the joint capsule
30
# displaced fat pads Anterior fat pad sign in the elbow is very ___ for intracapsular injury. Posterior fat pad sign is highly ___ for intracapsular injury. | sensitivity/specificity
Anterior fat pad sign is very **sensitive** Posterior fat pad sign is highly **specific**
31
What is the difference between stable and unstable fractures?
Stable fracture does not (or is unlikely to) move during the healing process Unstable fracture has a possibility of progressive biomechanical failure (movement) or neurologic insule (if spinal)
32
What force can lead to transverse fracture?
* Tensile * Angular/shear (force straight across)
33
What force can lead to oblique fracture?
Compression
34
What force can lead to spiral fracture?
Rotation/torsion
35
Spiral fractures appear to be ___ degrees to the axis of the bone.
<30
36
Oblique fractures appear to be ___ degrees to the axis of the bone.
about 45
37
When describing tubular bone fractures, what three concepts are used to describe the positions of bony fragments?
**Alignment**: distal fragent described in relation to the proximal **Apposition**: degree of bone contact at the fracture site **Rotation**: rotation about the longitudinal axis
38
# tubular bone fractures What is Bayonett apposition?
No degree of bone contact at the fracture site due to muscles contracting fragments
39
What is a subluxation?
Partial dislocation, usually in a synovial joint, where hyaline cartilages still touch
40
What is the best time frame to reduce a dislocation?
Within 6 minutes of injury
41
What is diastasis?
Displacement or frank separation of a slightly moveable joint (fibrous syndesmosis)
42
What are three examples of where diastasis may occur?
* Symphysis pubis (most commonly due to pregnancy/labor; not trauma) * Skull sutures * Tibiofibular syndesmosis (high ankle sprain)
43
How does osteochondral fracture occur?
Force (perpendicular to long axis of bone) sends convex surface into side of concave surface and **convex surface fails** | fracture through joint surface
44
What is osteochondritis dissecans (OCD)?
AKA osteochondral fracture
45
What are the most common locations of osteochondral fracture?
* Lateral aspect of medial femoral condyle * Talar dome * Capitulum
46
Osteochondral fractures require an ___ to visualize.
MRI arthrogram
47
What are the three phases of fracture repair and how do they appear?
1. Inflammatory - resportion along fracture line 2. Reparative - immature hazy callus 3. Remodeling - replacement of hazy callus with mature bone
48
Why are pediatric patients more likely to sustain incomplete fractures?
Bone is more plastic, so there is more deformation than true fracture
49
# pediatric specific injuries What direction of force will cause a Torus fracture?
**Compressive force** causes buckling in cortex and plastic deformation
50
# pediatric specific injuries What direction of force will cause a Greenstick fracture?
Angular force
51
You should suspect a physeal injury in any pediatric patient with ___.
physeal plate tenderness
52
# pediatric specific injuries What is a type 1 Salter Harris fracture?
Fracture through physis, often with slippage
53
# pediatric specific injuries What is the name for a type 1 Salter Harris fracture occurring at the proximal femur?
SCFE (slipped capital femoral epiphysis)
54
# pediatric specific injuries What is the name for a type 1 Salter Harris fracture occurring at the distal radius?
Gymnast fracture
55
# pediatric specific injuries What is the most common type of Salter Harris fracture?
Type 2 (physis and metaphysis)
56
# pediatric specific injuries What is a type 2 Salter Harris fracture?
Fracture through physis and metaphysis | most common Salter Harris type
57
# pediatric specific injuries What is a type 3 Salter Harris fracture
Fracture through physis and epiphysis
58
# pediatric specific injuries What is a type 4 Salter Harris fracture?
Fracture through physis, metaphysis, and epiphysis | both sides of physeal plate are broken
59
# pediatric specific injuries What is a type 5 Salter Harris fracture?
Crushed/crunched fracture appearing normal on x-ray
60
During what ages is someone most likely to have slipped capital femoral epiphysis (SCFE)?
10-15 during adolescent growth spurt
61
# sex distribution SCFE happens to ___ more frequently, but ___ are more likely to experience it bilaterally (within 1 year from femur to femur).
**males** more frequently **females** are more likely to experience SCFE bilaterally
62
What are the phases of fracture repair?
* Inflammation * Repair * Remodeling
63
What phase of fracture repair is occurring if there is a hazy callus around the fracture?
Reparative
64
# post fracture Is the complication of arterial injuries immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Immediate
65
# post fracture Is the complication of compartment syndromes immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Immediate
66
# post fracture Is the complication of gas gangrene immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Immediate
67
# post fracture Is the complication of fat embolism immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Immediate
68
# post fracture Is the complication of thromboembolism immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Immediate
69
# post fracture Is the complication of osteomyelitis immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Intermediate
70
# post fracture Is the complication of hardware failure following surgery immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Intermediate
71
# post fracture Is the complication of complex regional pain syndrome immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Intermediate
72
# post fracture Is the complication of post-traumatic osteolysis immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Intermediate
73
# post fracture Is the complication of refracture immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Intermediate
74
# post fracture Is the complication of myositis ossificans immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Intermediate
75
# post fracture Is the complication of myositis ossificans immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Intermediate
76
# post fracture Is the complication of synostosis immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Intermediate
77
# post fracture Is the complication of delayed union immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Intermediate
78
# post fracture Is the complication of osteonecrosis immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Delayed
79
# post fracture Is the complication of degenerative joint disease immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Delayed
80
# post fracture Is the complication of osteoporosis immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Delayed
81
# post fracture Is the complication of aneurysmal bone cyst immediate, intermediate, or delayed? | <1 week, 1-4 weeks, or 4+ weeks
Delayed
82
How much time must pass after a fracture for it to be classified as non-union or malunion?
>6 months
83
If a patient needs gatekeeping to multiple specialties and there is concern for malignancy or metabolic disease, what referral should be made?
Primary care provider
84
If a patient needs interventional and operative management of bone and joint conditions, what referral should be made?
Orthopedic surgeon/orthopedist
85
For an acutely unstable spine, refer to ___. For a chronically unstable spine, refer to ___.
acute = **emergency transport** chronic = **neurosurgeon**
86
Most ambulatory fracture/dislocation injuries will be referred to ___.
orthopedist
87
Canadian C-Spine Rules determine when to x-ray specifically for ___.
cervical trauma
88
What guidelines might you use for pre-authorization of advanced imaging?
ACR Appropriateness Criteria

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