Flashcards in Overview of Fractures Deck (30):
Define the types of fractures
1. Closed (Simple)
A. Overlying skin intact
2. Open (Compound)
A. Fracture breaks through skin
A. 2 or more bone fragments
7. Incomplete (greenstick or buckle/torus)
A. Occurs in children
B. Fracture that does not go through both cortices of bone
What are the different etiologies of fractures?
1. Compression fx
A. Vertebral fx
2. Stress fx
A. Caused by overuse
3. Pathological fx
A. Fx thru bone weakened by tumor or metabolic bone dz
4. Avulsion fx
A. Occurs at site of tendon attachment
What are the ABCS approach to reading an xray?
A- Adequacy, alignment
S- Soft tissues
What is adequacy/Alignment?
X-rays- min. 2 views (AP & Lat)
3 preferred, sometimes need 4 views
Alignment: anatomic relationship btw bones on x-ray
Normal x-rays should have nl alignment
Fractures and dislocations may affect the alignment on the x-ray
How are the bones examined in an xray?
Examine bones for frx lines or distortions
Examine the entire length of bone
Fractures may be subtle!
How is the cartilage assessed in an xray?
This means examine the joint spaces on x-rays (you cannot see cartilage on x-rays)
Widening of jt spaces signifies ligamentous injury and/or fractures
How are the soft tissues assessed in an xray?
This implies to look for soft tissue swelling and joint effusions
These can be signs of occult fractures
How is a fracture described?
1. Fracture location
A. Shaft of bone or intra-articular
B. Closed vs. open
2. Displaced vs. nondisplaced
3. Fracture pattern
5. Unusual circumstances
A. Tendon laceration, vascular or neuro injury and other trauma
B. Always state neurovascular status of involved extremity even if normal
Alignment is the relationship in the longitudinal axis of one bone to another
1. Angulation is any deviation from normal alignment
2. Angulation is described in degrees of angulation of the distal fragment in relation to the proximal fragment—to measure angle draw lines through normal axis of bone and fracture fragment- measure w/ goniometer
What imaging studies are used for fractures? What are they used for?
1. Plain x-rays
A. AP & Lateral: can visualize most fxs
2. Bone scan
A. Shows inc uptake @ site of occult fx/stress fx
3. CT scan
A. Allows visualization of bone’s articular surface otherwise obscured by overlying structures
A. Assess for stress fracture
B. Assess for soft tissue involvement too
What is the general treatment for a fracture?
Treat with analgesia, immobilization and Call Ortho after adequate stabilization of patient
How is an open fracture treated?
1. REFER TO ER/Call ORTHO STAT
2. Must be debrided and irrigated in OR within 6-8 hrs of injury.
3. IV Abx ideally within 3 hrs of fx & 2-3 days post surgery
4. Know pts tetanus status
5. Immobilization & fixation to preserve function
How is the anatomic location of the fracture described?
1. Include if it is left or right sided bone
2. Include name of bone
3. Include location:
B. To aid in this, divide bone into 1/3rds
How are dislocations described?
Dislocations are named by the position of the distal segment
Where are fractures more likely in children?
1. Growth plate (physis) is more susceptible to fx than injury to attached ligaments
2. Swelling & tenderness over physis- common
3. Comparison films very helpful!
What are the 6 ossification centers at the elbow?
1. CRITOE= Capitellum, Radius, Internal(medial)epicondyle, Trochlea, Olecranon, External(lateral)epicondyle
2. 1-3-5-7-9-11 yrs old
correlates with the ages that the ossification centers develop at the elbow in children
What is a salter harris classification?
1. Fxs involving growth plate (or physis)
2. Risk of complications involving the growth plate inc, as Type inc
A. Type I fractures are at low risk and Type V are at greatest risk
B. Negative x-rays DO NOT RULE OUT a Salter- Harris Type I fracture
What are the 2 types of incomplete fractures?
Describe a greenstick fracture.
1. Transverse fx w/ only one cortex disrupted
2. Occur in long bones when bowing causes break in one side of cortex
3. When angulation of fx < 15 degrees, long arm or leg cast can be applied for 4-6 weeks
4. When angulation > 15 degrees, Ortho
Describe a Torus/Buckle fracture
1. One side of cortex buckles as result of compression injury/ impaction injury
2. Fall on outstretched hand
When is an emergent ortho referral indicated?
1. Neurovascular injury
2. Fractures that are open/unstable
3. Unreduced joint dislocation
4. Septic arthritis
When is an urgent ortho referral indicated?
1. Fractures: closed, stable
2. Reduced joint dislocation
3. Locked joint
What is an early ortho assessment indication?
1. motor weakness
2. constitutional sxs
3. multiple joint involvement
What is a routine ortho assessment indication?
1. Failure of conservative treatment
2. persistent numbness and tingling
What is a type I salter Harris fx?
1. S: slipped
2. epiphyseal slip, separation through the physis
3. Good prognosis, non-operative
What is a type II salter Harris fx?
1. A: Above the growth plate
2. fracture through a portion of the physis (growth plate)
3. Good prognosis, non-operative
What is a type III salter Harris fx?
1. L: lower than the growth plate
2. fracture through a portion of the physis (growth plate) that extends through the epipyphsis and into the joint
3. Often unstable
What is a type IV salter Harris fx?
1. T: Through the growth plate
2. fracture across the metaphysis, physis (growth plate), and epiphysis
3. Prone to limb length discrepancies