Week 2: Fractures

Question 1

Complete Fracture

Answer 1

A fracture that results in discontinuity between two or more fracture fragments, bone broken all the
way through

Question 2

Incomplete Fracture

Answer 2

When a bone cracks and bends but does not completely break through the entirety of the bone;
the bone does not break into separate fragments

Question 3

Closed Fractures/Simple Fractures

Answer 3

Any fracture where the overlying skin is intact. Bone ends do not penetrate through overlying soft tissues
or skin. Can also be referred to as a ‘simple’ fracture

Question 4

Compound Fracture/Open Fracture

Answer 4

Any fracture where the over lying skin is disrupted; fragment(s) of bone protrude through the skin. Also known as an ‘open’ fracture. This type of fracture exposes the wound to possible infection

Question 5

Transverse Fracture

Answer 5

A complete fracture that is perpendicular (90 degrees) to the long axis (shaft) of the bone
Cause: direct blow or is a
fracture within pathological
bone

Question 6

Oblique Fracture

Answer 6

A fracture that runs a course of approximately 45 degrees to the long axis of the bone
Cause: angulation or by both angulation and compression forces

Question 7

Spiral Fracture

Answer 7

A fracture that encircles the bone
shaft; usually longer than an oblique fracture
Caused by torsional forces: the twisting of a bodily organ or part on its own axis

Question 8

Avulsion Fracture

Answer 8

Small bone fragments torn off bony prominences at sites of a muscle origin. They are usually the result of indirectly applied tension forces within attached ligaments and tendons rather than direct blows
Example: tip of distal fibula or base of the 5th metatarsal
Seen best on oblique foot projection

Question 9

Comminuted Fracture

Answer 9

Fracture composed of more than two fracture fragments

Question 10

Segmental Fracture

Answer 10

Segment of shaft separated from the rest of the bone by proximal and distal fracture lines

Question 11

Butterfly Fragment

Answer 11

Elongated triangular bone fragment

Question 12

Compression Fracture

Answer 12

A fracture caused from compression forces that result in compaction of bone trabeculae
The bone decreases in length or width
Most compression fractures occur in the vertebral bodies (wedge #) as a result of flexion of the spine; they may also be seen as impacted fractures of the humeral or femoral heads
Common causes: trauma, osteoporosis and
pathological fractures from cancer, Paget’s
disease or osteomyelitis

Question 13

Depressed Fracture

Answer 13

A fracture commonly found in the cranial bone with depression of the bone toward the brain
Often star shaped (stellate) with
fracture lines radiating outwards from central point
Tangential views can be done to show the amount of depression

Question 14

Greenstick Fracture

Answer 14

An incomplete fracture with the opposite cortex intact
Greenstick fractures are found almost exclusively in infants and children due to the softness of their cancellous bone

Question 14

Stress/Fatigue Fracture

Answer 14

Result of repeated small
stresses/pressures on a bone Occurs in lower limbs, often feet

Question 15

Torus (buckle) Fracture

Answer 15

One cortex intact, but buckling or compaction of other
cortex (side)

Question 16

Bowing Fracture

Answer 16

Not actually a break/fracture
Stress bends bone and deforms shape but does not fracture
Long bones, especially radius & ulna
If stress continues, becomes greestick

Question 17

Fissure Fracture

Answer 17

Break but does not pass through bone

Question 18

Undisplaced Fracture

Answer 18

A fracture that is broken into two or more pieces but bone fragments remain in normal alignment

Question 19

Longitudinal Fracture

Answer 19

A fracture that is parallel to the long axis of the bone and may cause displacement of bone fragments
Cause: impact and repetitive stress injuries
Usually referring to long bones, but can refer to the
skull, specifically temporal bone fracture

Question 20

Displaced Fracture

Answer 20

A break in which the two ends of a fractured bone are separated and out of their normal position
(alignment)

Question 21

Impacted Fracture

Answer 21

A fracture in which fragments from the SAME bone are pushed together; one fragment is driven into the other fragment from the same fractured bone

Question 22

Dislocation

Answer 22

Bone out of joint
Bone is no longer in contact with normal articulation
Shoulder is the most commonly dislocated joint
Usually anterior dislocation
From external rotation and abduction
May cause fracture

Question 23

Subluxation

Answer 23

Bone partially out of joint
Partial loss of continuity with joint surfaces
Often spine, shoulder, kneecap, elbow

Question 24

March Fracture (Stress/Fatigue Fracture)

Answer 24

Recurrent stress such as standing for long periods of time, walking and running long distances, and heavy or unaccustomed exercise Hairline fracture of the distal third (shaft) of a metatarsal bone, usually, the 2nd or 3rd metatarsal bones of the foot r calcaneus, tibia/fibula shaft, femur shaft/neck, ischial/pubic rami Often missed on initial radiographs and visualized on follow up images 10-20 days later (callus formation visible)

Question 25

Colles Fracture

Answer 25

A transverse fracture of the distal radius with posterior (dorsal) displacement of distal fragment Fragment often over-rides bone end. Often has avulsion fracture of ulnar styloid process also Most common wrist fracture Most common cause: FOOSH

Question 26

Bennet’s Fracture

Answer 26

Fracture of the base of the 1st metacarpal bone which extends into the carpometacarpal (CMC) joint

Question 27

Bimalleolar Fracture

Answer 27

Includes both malleoli, a transverse fracture of the medial malleolus and a low oblique or spiral fracture of the distal fibula

Question 27

Smith’s Fracture

Answer 27

A fracture of the distal radius with anterior displacement of distal fragment Sometimes referred to as a “reverse Colles fracture” Causes: A fall onto a flexed wrist, a direct blow to the back of the wrist

Question 28

Boxer’s Fracture

Answer 28

A transverse fracture of the neck of the 5th metacarpal with volar (palmar) angulation of the distal fragment

Question 29

Trimalleolar Fracture

Answer 29

A three-part fracture of the ankle involving the medial malleolus, the lateral malleolus, and the posterior aspect of the tibial plafond (posterior malleolus)

Question 30

Tibial plafond

Answer 30

Sometimes called pilot fracture. Fracture of the weight bearing articular surface of the distal tibia. At ankle, usually comminuted (broken into three or more pieces), often affects both tibia and fibula.

Question 31

Salter- Harris Fracture

Answer 31

A fracture involving the epiphyseal plate (growth plate) of a pediatric bone

Question 32

Intertrochanteric Fracture

Answer 32

A proximal hip fracture between the greater and lesser trochanters of the femur. Cause: trauma and falls. Treatment: surgical intervention is used to treat trochanteric fractures by Open Reduction and Internal Fixation (ORIF) using various internal fixation

Question 33

Monteggia Fracture

Answer 33

An isolated fracture of the shaft of the ulna associated with anterior dislocation of the radius at the elbow These fractures are common in pediatric patients (ages 4-10 years) Cause: FOOSH injury Most forearm fractures involve both bones Always include both joints to check for other fractures/dislocation!

Question 34

Supracondylar fracture

Answer 34

A fracture of the distal humerus above the epicondyles Rare in adults but very common in pediatric patients Cause: FOOSH; hyper-extension of the elbow

Question 34

Galeazzi Fractures

Answer 34

Are characterized by a fracture of the distal radius with dislocation of the ulna at the wrist Most common in pediatric patients, can affect the growth plate on the ulna. Cause: FOOSH Most forearm fractures involve both bones Always include both joints to check for other fractures/dislocation!

Question 35

Jones Fracture

Answer 35

One of most common foot injuries Can occur stepping off curb or on stairs Transverse fracture of the base of the fifth metatarsal = type of avulsion fracture Sometimes confused with apophysis of child

Question 36

Jefferson Fracture

Answer 36

Fracture to C1 vertebrae (atlas) of neck, occurs to the ring of the atlas. Fracture to (one or) both anterior and posterior arches with fragment displacement

Question 37

Burst Fracture

Answer 37

A comminuted fracture of the body of a vertebra where the vertebral body is crushed in all directions From large axial load More severe than a simple compression fracture because of danger to spinal cord from bone fragments

Question 38

Hangmans Fracture

Answer 38

The result of acute hyperextension of the head. Fracture of the arch of C2, anterior to the inferior facet. Usually associated with anterior subluxation of C2 on C3. Is an injury from hanging, but most often seen in MVC now

Question 39

Clay Shovelers Fracture

Answer 39

Avulsion fracture of spinous process of lower cervical or upper thoracic vertebra. Displacement of fragment. Seen on image as double shadow/double spinous process sign. Can be missed if area not seen well on imaging

Question 40

Linear Fracture

Answer 40

A fracture that extends parallel to the long axis of a bone but does not displace the bone tissue Linear fractures are commonly found in the skull Sharp lucent line that is often irregular or jagged Diastatic fracture = intersects suture and courses along it, causing sutural to separate

Question 40

Odontoid Fracture

Answer 40

Fracture to odontoid (dens/peg) of C2 vertebra of neck. Usually transverse and at base of the odontoid. This is why we do the open mouth c-spine x-ray image Shows as lucency within dens

Question 41

Basilar Skull Fracture

Answer 41

Fracture of base of skull Trauma Suggestive finding for fracture may be air-fluid level in the sphenoid sinus seen on lateral projection of skull using horizontal central ray

Question 42

Contrecoup Fracture

Answer 42

An injury or fracture on the opposite side from where the injury occurred

Question 43

Blow Out Fracture

Answer 43

A fracture of the floor of the orbit caused by an increase in intra-orbital pressure due to traumatic blow. Orbital contents may herniate into maxillary sinus

Question 44

Tripod Fracture

Answer 44

Fracture of the zygomatic arch and the orbital floor or rim combined with separation of the zygomatico-frontal suture

Question 45

Le Fort Fracture

Answer 45

Bilateral and horizontal fracture of the maxilla Pterygoid plates must be fractured Effectively separates the midface from the skull